Manual therapy
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Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. ⋯ For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.
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Complex regional pain syndrome (CRPS) is the newest name for the confusing conditions of reflex sympathetic dystrophy and causalgia. The epidemiology and the signs and symptoms of these conditions are discussed. Although much is only poorly understood about the aetiology of CRPS, the roles of neuropathic pain, prolonged inflammation and psychological factors are becoming clearer. Physical therapies remain the lynchpin of management but the roles of anti-inflammatory medication, sympathectomies and a team approach are emphasized.
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Review Comparative Study
Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients.
Chronic pain syndromes such as chronic low back pain are responsible for enormous costs for health care and society. For these conditions a pure biomedical approach often proves insufficient. ⋯ The main assumption is that pain and pain disability are not only influenced by organic pathology, if found, but also by psychological and social factors. In this contribution, a behavioural analysis of chronic musculoskeletal pain will be discussed, with special attention to the role of pain-related fear in the development and maintenance of chronic pain disability, and the behavioural rehabilitation perspective of chronic pain management.