Der Orthopäde
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At least 5 million patients with chronic and severely debilitating pain exist among the adult population in Germany, i.e. 8% of this population. Various biological and psychosocial risk factors contribute to the continuing chronicity of pain, resulting in enormous direct and indirect costs totalling an estimated 38 billion euro annually. ⋯ In contrast, more recent approaches of multimodal treatment, including medical, psychological and behavioral components, have shown a significant and lasting effect in patients with a high incidence of workplace incapacitation and sick leave. In particular, the GRIP pilot project (Göttingen Intensive Back Project) has resulted in an increased rate (to 200%) of return to the workplace and in a decrease in health system expenses to 50% of the pretreatment level.
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Clinical Trial Controlled Clinical Trial
[The Explanatory Model-Interview in the diagnosis of orthopaedic pain patients].
This study aims to clarify weather the Explanatory Model Interview (EMIC, Weiss, 1997) can detect differences between pain patients with somatoform disorders and pain patients without any psychiatric disorder. We consider the importance of psychological symptom reporting, somatic illness attribution and the subjective experience of exhaustion. ⋯ Most pain patients with somatoform disorders report psychological distress when they are encouraged. In spite of this emotional strain, most of the pain patients with somatoform disorders attribute their pain complaints to somatic causes. The conspicuous importance of exhaustion in the attribution of patients with somatoform disorders confirms clinical observations and requires further research.
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An overview is given on the current classification, description and treatment of chronic pain with causally relevant psychological factors. It is based on the "practice guidelines on somatoform disorders" and on a thematically related meta-analysis. ⋯ A modified psychotherapy for (somatoform) chronic pain is outlined. Finally, this aetiologically oriented psychosomatic-psychiatric approach is compared to psychological coping models for chronic pain.
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Review
[Visualisation of phantom- and backpain using imaging techniques. Implication for treatment].
If patients with chronic low back pain are stimulated in the painful region, an expanded representation of the back in the primary somatosensory cortex becomes visible that increases with chronicity. This "pain memory" might play an important role in the chronicity process. In patients with phantom limb pain, e.g. subsequent to the amputation of an arm or leg, a shift in the representation of neighboring areas into the deafferented area in primary somatosensory cortex has been observed. ⋯ The modulation of plasticity and phantom limb pain by anesthesiological manipulation, the use of NMDA receptor antagonists and opioids is presented. Behaviorally relevant stimulation, e.g. by the use of a myoelectric prosthesis or sensory discrimination training can also influence the cortical somatosensory pain memory. More recent studies focus also on brain areas such as the cingulate gyrus believed to be involved in the affective processing of pain.
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The present article presents an overview of neurophysiological and neuroanatomical mechanisms that may be involved in the transition from acute to chronic muscle pain. The report is based on data that were obtained in studies on anaesthetised rats in which an acute or chronic myositis was induced experimentally. The inflamed muscle tissue was evaluated using histochemical and immunohistochemical methods, and the impulse activity of single muscle nociceptors or dorsal horn neurones was recorded in electrophysiological experiments in vivo. ⋯ Chronic spontaneous muscle pain, however, appears to be due to a lack of NO. The final step in the transition from acute to chronic pain involves structural changes that perpetuate the functional changes. In rat experiments employing nerve lesions or muscle inflammation, such morphological changes become apparent within a few hours after the lesion.