Articles: chronic-pain.
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In pain clinics, thorough documentation of patient-related data is essential for analysis of patient history, long-term evaluation of diagnostic and therapeutic procedures, and research on the etiology and epidemiology of chronic pain syndromes. With these requirements in mind, we realized a microcomputer documentation system based on a commercial data-base software concept (dBASE). Each patient's data are stored in three different sections: data for identification, basic data (mainly diagnostic findings), and treatment related follow-up data. ⋯ The microcomputer documentation system offers listings for administration as well as effective patient scheduling thanks to a recall system by date of last contact, selected therapeutic procedures and any other item in the medical record. A mail-merge service can be applied, which is particularly useful for follow-up-studies. The documentation system means routine work can be standardized and performed in an economical manner, with the ultimate aim of enhancing the quality of pain therapy.
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For the present investigation 31 out-patients suffering from chronic pain received a pain diary, that is a booklet in which they recorded their pain level on visual analogue scales and daily activities several times during a day. We used weekly interviews and the patient's records in the diary to evaluate the patient's compliance and the influence of a pain diary on the pain perception and on the physician-patient-interaction. We found that most of the patients were willing and able to use the pain diary. 30 out of 31 patients kept the diary voluntarily for an average period of 4 weeks. 70% of the patients regarded the pain diary as helpful irrespective of whether or not they considered it at the same time as burden. ⋯ Patients from this study reported a better control over their pain and improved conciousness of their own body. As the patient plays an active part the pain diary promotes an equal cooperation between physician and patient. The new information derived from a pain diary enables both patient and physician to alter their point of view.
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This epidemiological questionnaire-study of 362 patients suffering from chronic pain related to musculoskeletal disorders showed the following results: Most musculoskeletal pain syndromes are located in the head and back areas (57.3%). Patients who seek treatment in an orthopedic pain clinic suffer from at least moderate pain according to the verbal rating scale and from pain equal too or more than 50 on to the numeric rating scale. For most patients (51.9%) the duration of the pain has been between 1 and 10 years. ⋯ Most patients with chronic pain consult 2 to 6 doctors. For typical orthopedic pain syndromes most patients consult an orthopedist. Patients with chronic headaches consult an orthopedic specialist about as frequently as neurologist or internist specialist.
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Chronic pain is a complex experience that may change the life of the patient totally. Being influenced by numerous factors, communication between the physician and the patient on such a complex experience is not always easy. ⋯ Our results showed that the new method is appropriate to evaluate the intensity of pain in patients with chronic pain, but no to explore the patient's psychological state. The patients' assessment showed clearly that they preferred the dolorimeter to evaluate their pain intensity while they preferred a verbal scale (Profile of Mood States) to describe their mood state.
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In the past the view has often been expressed that children are less sensitive to pain than adults as a result of the assumption that their nervous system is not as well developed. According to this theory, newborns were not supposed to feel pain at all, and for this reason minor surgery was often performed with inadequate anesthesia. Evidence in the more recent literature and the regular choice of "pain in children" as a topic for congresses exemplify the more and more widespread belief that children of all ages can feel pain and, relative to their developmental stage, suffer accordingly. ⋯ As cognition develops further, the patient's own concept of health and sickness changes, as does the ability to express feelings of pain. In the pathogenesis of pain in children, the dominant types are nociceptor pain (e.g., as a result of trauma or infection) and pain resulting from malfunction (e.g., physical malposition, migraine), whereas nervous pain occurs less frequently. Pediatricians should pay particular attention to the treatment of acute and chronic pain in children.