Articles: chronic.
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During the 1960s, it was observed that the tricyclic antidepressant imipramine was effective in the treatment of neuralgia, myalgia, and pain in carcinoma. Similarly, in other studies, clomipramine was also found to have an analgesic effect. The sedative antidepressant amitriptyline has proved effective in migraine prophylaxis, chronic tension headache, and psychogenic musculoskeletal and neuralgic facial pain. ⋯ The remaining tricyclic and the tetracyclic antidepressants have not been sufficiently well evaluated. This is also true of monoamine oxidase inhibitors, of which individual reports to date suggest are probably also effective as analgesics. A scientific investigation into the possible differences in the effectiveness of various antidepressants in specific chronic pain conditions is an important task for the future.
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The perception and expression of pain are primarily psychological phenomena and are not directly correlated with the intensity of the nociceptive stimulus. They are often influenced by earlier experiences of pain, and also by current expectations and fears. The cancer patient interprets pain as a sign of the continued existence and of the progression of the malignant disease: if the pain can be controlled the patient will take this as an indication that the underlying disease can be cured. ⋯ In particular, antidepressants and neuroleptics have become an important component of the treatment of chronic pain in cancer patients. Due consideration of the emotional and motivational status of the patient will make it possible to choose between the different effect profiles of these drugs. However, the use of psychotropic drugs should complement, and cannot replace, empathic care from the physician.
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Psychological methods for the treatment of chronic pain have been developed within the contextual framework of behavioral medicine during the past few years. Some of these self-control approaches focus on the patient's capacity to cope actively with pain. Standardized self-control training for outpatient group treatment for patients with chronic pain is described. ⋯ Thirty-three patients with chronic back pain were assigned either to one of four treatment groups (n=22) or to a waiting list control group (n=11). After 12 sessions of group treatment, patients showed significant improvement regarding daily ratings of pain intensity and mood and a significant decrease in depression and general physical complaints other than pain; the waiting list patients remained the same. Results showed good maintenance at the half-year follow-up.
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Special aspects of pain in children are pointed out, and the range of relevant conditions and their frequency are compared with adult pain problems. Headache and especially migraine, with incidences of up to 50% and 10%, respectively, are the most common painful conditions to be treated in the pediatric age group. Many less frequent chronic painful disorders claim the need of special, mostly neuropediatric, knowledge; optimal diagnostic precision is important for good therapeutic results. ⋯ Another problem is that of pain assessment in infants and children; some new diagnostic tools, such as color scales and the Smiley analog scale, can help to solve these specific difficulties. Furthermore, the prediatrician accepts responsibility for the patients' future as adults and is therefore involved in the early prophylaxis of analgesic abuse. The actual and future work of pediatric pain clinics, the conditions in such institutions and the philosophy behind them are presented, and the necessity for research is pointed out.
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In Western industrial countries, low back pain is one of the most frequent causes of illness. Between the 4th and 5th decades of life approximately 80% of adults complain of low back pain, lasting for fairly long periods. About 10% of this population must undergo disc surgery once during life. ⋯ CT control examinations showed clear regression in the extent of disc herniation in 15 patients, in 18 a moderate decrease, and in 9 cases the CT findings had not changed. A favorable tendency towards regression was observed in disc herniations at the level of L5-S1 and in cases showing sequestration of the disc. Herniations of the disc at higher levels between L4-5 and L3-4 or a lateral herniation, reaching the intervertebral foramen, showed on unfavorable prognosis.