Articles: pain-clinics.
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The aim of the study was to evaluate an educational video designed to modify the pain concept of chronic pain patients. It is commonly described that chronic pain patients foster an illness model which is dominated by purely medical assumptions about causes of pain and its modulation and treatment. Furthermore the mostly unrealistic hope for total pain relief which is expected from the pain expert guides the patients' seek for help. ⋯ The Ss participating in the study were 47 chronic pain patients of a pain ambulance and 42 patients of a pain clinic (inpatient setting). The results showed that after viewing the pain video the groups differed significantly in their pain concept as predicted. The use of an educational video, like the one evaluated, seems useful to initiate first steps in illness concept modification by expanding and enriching the patients attitude by assumptions about the influence of psychological factors on pain maintenance and management and shaping realistic attitudes towards treatment.
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In parallel with the development of the various electrophysiological methods now available, the clinical syndrome of migraine has been repeatedly analyzed with the aid of these tools, in attempts to track its course with reference to electrophysiological parameters. A survey of the international literature reveals the following EEG findings. (1) In patients with different forms of headache without structural lesions the distribution of normal and abnormal EEG recordings during headachefree intervals resembles that seen among healthy subjects. (2) In common migraine, nonfocal and nonspecific abnormalities are reflected in up to 65% of all EEG recordings during the migraine-free interval. (3) Focal EEG abnormalities during a migraine attack are relatively rare, generally occurring only during migraines with transient focal neurological disturbances. (4) It is very rare for there to be permanent focal changes that are apparent during both pain-free intervals and migraine attacks. In the presence of such changes very careful diagnosis is necessary to exclude symptomatic lesions. (5) In up to 53% of migraineurs a few minutes' hyperventilation leads to generalized slow, wide-amplitude, sometimes episodic waves in the EEG. Similar changes also occur in healthy subjects, but are less common, less intense and of shorter duration. (6) There is a statistically significant correlation between the occurrence of a migraine and EEG activation by photic stimulation at frequencies over 20 Hz. (7) No unequivocal results obtained in large series of patients with train mapping are yet available.
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A completely new classification system for headache disorders, cranial neuralgias and facial pain has been prepared by a headache classification committee working within the International Headache Society (IHS). The committee is made up of an international body of experts, who spent almost 3 years on the preparation of the classification, publishing it in 1988 (Cephalalgia 8 Suppl 7ratio1ff., 1988). The German translation appeared a year later (Nervenheilkunde 8ratio161-203, 1989). ⋯ The advantages and the problems encountered are discussed. On balance, the new IHS classification is proving to be a very useful basis for the diagnosis of painful conditions affecting the head and face. It is indispensable for a modern headache clinic.
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The analgesic effectiveness of physical therapy in rheumatology is dependent on the differentiated clinical picture (joint, soft parts, spinal column, musculature) and on the differentiated therapeutic remedy (intensity, duration of single treatments, frequency, duration of therapeutic series). Physico- and kinesitherapy can be distinguished with regard to objective and subjective doses; manual therapy is between them. ⋯ The problem "rheumatism and pain" mainly exists at the level of "chronic"; diagnostics of movement function (articular and muscular functions) on one hand and dosage of therapeutic remedies (drugs and remedies of physiotherapy) on the other are the guidelines. Course (rehabilitation) as well as onset (prevention) of rheumatic clinical pictures determine the further strategy of pain therapy.