Articles: chronic-pain.
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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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The new orientation concerning the therapy of chronic pain has brought about essential progress during recent years. However, physical therapy is often disregarded. Therefore, various possible ways of influencing pain by physical therapy are presented. ⋯ Central pain control by physical therapy is investigated most frequently and is of essential importance. It is also of value to take into consideration the psychotherapeutic effects of physical therapy. The integration of physical therapy into a complex treatment schedule may lead to further progress in the treatment of patients with pain.
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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.
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Treatment of chronic low back pain (CLBP) is not only expensive, but is frequently not totally effective. For these reasons, it is important that the risk factors that correlate with the development of chronic pain be considered at the early stage of acute low-back pain (ALBP) in order to implement early treatment to prevent the condition from becoming chronic. ⋯ In light of the need to contain costs, a program for the prevention of chronic back pain can only be provided for those ALBP patients with an increased risk of having CLBP. Further research on the prevention on CLBP is needed.
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Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. ⋯ Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain -therefore, they should be given "by the clock". Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.