Articles: back-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Operant-behavioural and cognitive-behavioural treatment for chronic low back pain.
Fifty-eight outpatients with chronic low back pain were randomly allocated to one of six experimental conditions. Four conditions were designated as treatment conditions and two as control conditions. The four treatment groups consisted of: cognitive treatment (either with or without relaxation training) and behavioural treatment (either with or without relaxation training). ⋯ However, these differences were only weakly maintained at 6- and 12-month follow-ups. The behavioural conditions improved significantly more than the cognitive conditions from pre to posttreatment on the self-rated measure of functional impairment, but this difference was not maintained at 6- and 12-month follow-ups. Progressive relaxation training was found to make little contribution to either cognitive or behavioural treatments.
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Comparative Study
A comparison of two-point discrimination threshold of tactual, non-painful stimuli between chronic low back pain patients and controls.
Differences in pain sensitivity between chronic pain patients and healthy controls have been reported. Seltzer and Seltzer extended this line of research in studying the sensitivity to non-painful stimuli. They reported that the 2-point discrimination threshold of chronic pain patients was higher than that of control subjects. ⋯ Therefore, in the present study we tried to replicate the findings in a group of chronic low back pain patients using a design that was believed to be methodologically stronger. Replication failed: no evidence was found for the hypothesis that chronic pain patients are less sensitive to non-painful stimuli. Further studies on various defined types of acute and chronic pain patients are required.
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Psychother Psychosom · Jan 1991
Personality traits in patients with acute low-back pain. A comparison with chronic low-back pain patients.
This study investigates the possibilities to identify, within a group of acute low-back pain patients, individuals with psychogenic etiology to pain. 26 acute back pain patients and 25 healthy control subjects were tested with the Minnesota Multiphasic Personality Inventory Hysteria: (Hs), Hypochondria (Hy), Depression (D); Cesarek-Marke Personality Scale: Aggression (Agg), Defence of status (Dst), Guilt (Gui); Mood Adjective Check List: (Hedonism, Activity, Calmness = Hed, Act, Clm) and a 'pain questionnaire' including 'pain drawing'. Differences between groups and correlation patterns between test variables indicate that a combination of Hs, Hy, D, Dst, Gui, Hed, Act, Clm as well as predisposition to somatization, Som (a quantification of pain drawing) provides a useful predictive screening instrument.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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Many studies have demonstrated that cancer pain can be relieved in most cases by suitable analgesic medication. Patients with a diagnosis of "intractable cancer pain", however, are referred to our pain clinic nearly every day. A retrospective study of 1140 patients was therefore performed to evaluate the pain mechanisms and whether analgesic pretreatment had been adequate. ⋯ The principal causes for the inadequacy of the analgesic pretreatment were: failure to prescribe analgesics (10% of the patients), irregular intake schedule or prolonged intervals between applications (66%), underdosage of nonopioid analgesics (27%) or opioids (42%), and withholding of nonopioid analgesics (30%), strong opioids (14%), or co-analgesic drugs (17%), although their prescription was indicated. The severe pain was thus caused in many patients by simple mistakes in the prescription of analgesics. Terms like "intractable" should be used with caution when referring to cancer pain because they are often unreflected and can make patients and physicians feel helpless or insecure.