Articles: back-pain.
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Dtsch. Med. Wochenschr. · Sep 1994
Review Case Reports[The interdisciplinary aspects of notalgia paraesthetica].
For 3 years a 75-year-old man with type II diabetes had been suffering from paroxysmal pruritus in a circumscribed area of brown discoloration of the skin over the left should blade. This condition, also known as notalgia paraesthetica, is a rare, but perhaps underdiagnosed, neurocutaneous entity, a largely sensory neuropathy due to a muscular compression phenomenon. ⋯ Purely symptomatic local capsaicin treatment decreased the pruritus temporarily. Endocrinological diagnosis failed to demonstrate multiple endocrine neoplasia (MEN) syndrome 2A, which has been frequently described in association with notalgia paraesthetica.
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The therapeutic objectives of conventional back schools are a) instruction of people with and without back pain to use their backs according to currently accepted ergonomic principles, b) improvement of the cardiovascular performance of back school participants and c) acquisition of knowledge of simple methods of pain and stress management. Due to the diversity of back pain causes and the biopsychosocial complexity of back pain as the therapeutic target, back schools can never be the sole solution of a multifaceted problem. The prime objectives of this review are to describe the recent back school curriculums and to define possible therapeutic components of future back schools.
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Chronic back pain is a major consumer of costly healthcare resources in the Western world. Patients' suffering affects their families and associates, leads to diminished self-confidence, and prevents their effective participation in the workplace. Although medical treatments and analgesics are generally successful in treating acute back pain, and some patients recover spontaneously, conventional approaches are less successful in dealing with chronic pain and may be contraindicated. ⋯ Part 2 provides a step-by-step description of how to incorporate basic psychological techniques and physical therapy procedures for chronic pain sufferers. Patient and therapist cooperate in operant activities, with the patient monitoring progress and carrying out regular home-work assignments as he or she seeks to perform target activities; applied relaxation encourages the patient to cope with pain by disrupting the connection between anxiety, despair, and pain. The techniques outlined are suitable for dealing with other musculoskeletal conditions as well as with chronic back pain.