The Clinical journal of pain
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Acute and chronic neck pain and headaches are a major medical, industrial, and financial problem. In many cases, the pathophysiology is unknown, and the disability is often greatly in excess of the apparent tissue pathology and physiological impairment. Diagnosis and management of neck pain and cervicogenic headache calls for a rational and comprehensive approach. Many cases will have no identifiable pathology, and the pain and disability will continue despite the best efforts of all concerned.
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The following discussion demonstrates a clinical need for a physical education service in a multidisciplinary pain center. Weight loss, and physical and aerobic conditioning are essential aspects of managing pain. By improving patient care and increasing one's pain center attraction, physical education and aerobic research centers can also increase departmental revenues.
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Sixty-nine patients undergoing spinal cord stimulation (SCS) were studied for a period of up to 8 years. Indications, implantation techniques, and stimulation systems are presented in this article. Pain-suppressor effects of SCS are reviewed, assessing the clinical efficacy over time as well as complications with the stimulation device. ⋯ Decrease of the efficacy of pain alleviation occurs during the first 3 years after implantation. Most failures are noted in patients presenting with failed back surgery. This study also demonstrates that SCS systems should offer the capability of both monopolar and bipolar stimulation modes by the use of multipolar electrodes.
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The relationship of personality variables and patient recruitment to pain coping strategies and psychological distress was assessed in a Dutch sample of 111 chronic tension headache patients. Using the Coping Strategy Questionnaire (CSQ), high scores on the factor of helplessness proved to be associated with psychological distress. ⋯ Patients who reported shorter daily pain periods indicated a lower level of active coping with pain. It is concluded that future research must be more attentive to the complex interactions between personality variables, environmental factors, and the coping demands posed by the nature of the pain problem.