Articles: chronic-pain.
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Epidural steroid injections are frequently used in the conservative treatment of backache, although they are still subject to critical discussion. Relief of pain is attributed to the anti-inflammatory effect of the steroid. During a 3-year period, 53 patients with back pain or differing aetiology were treated with one or more epidural injections of 14 mg betamethasone (2 ml Celestan) in a prospective and retrospective fashion. ⋯ Patients with acute pain (up to 6 months) responded better than patients with chronic symptoms. No significant correlations were detected between response and other characteristics, e.g. age, sex, number of injections, type of pain, intensity of pain, or psychological overlay. For patients with acute pain epidural steroid injections seem to be a safe, appropriate and promising procedure.
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In a retrospective, controlled clinical study the life events of 35 patients suffering from chronic low back pain (LBP) and a matched sample of 23 patients with neurotic depression (ICD 300.4) were investigated. The pain patients formed two groups: 19 patients with definite organic diagnosis (IASP code 530.96) and 16 without (adequate) organic lesion (IASP code 510.99). Somatic diseases (other than LBP), injuries and operations, as well as psychic trauma (feelings of shame, narcissistic traumatisations and object losses) were defined and counted as documented in the patient's histories. ⋯ Object losses occur equally often in all groups, apart from the initial year, when depressive patients have to cope with even more losses than the others. These results are discussed considering the development of chronic pain syndromes, the influence of age and their consequences for models of illness. There is convincing evidence, that physical injury is neither a necessary nor a sufficient condition for the development of chronic pain and that chronic pain is in essence an emotional disease based on unresolved unconscious conflicts requiring psychotherapy.
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The rationale for the use of spinal cord stimulation (SCS) in the treatment of chronic pain arose from Melzack and Wall's gate theory of the control of pain (1965). Originally electrodes were placed directly on the spinal cord via open operation, while now they are placed by means of direct puncture the epidural space. ⋯ The implantation of an SCS system is a surgical procedure, which requires the highest standards in asepsis. The operation and its complications and ways of avoiding them are described.
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The chronic headache patients in our neurological outpatient department treated between 1985 and 1987 were retrospectively studied. One-third (n=44) were examined and questioned about the efficacy of treatment. Initial treatment in the outpatient department had been at least 2 years before the study, thus allowing evaluation of the long-term course of the illness. ⋯ Adequate consideration of the non-medical therapeutic elements should be ensured in such structures headache therapy. A uniform classification of headache and records of the course in the form of headache diaries are essential for comparing the results. A sufficiantly long post-therapy observation period should be allowed in order to facilitate evaluation of the therapeutic response.
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A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.