Articles: chronic-pain.
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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.
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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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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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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.