Articles: patients.
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The analgesic effectiveness of physical therapy in rheumatology is dependent on the differentiated clinical picture (joint, soft parts, spinal column, musculature) and on the differentiated therapeutic remedy (intensity, duration of single treatments, frequency, duration of therapeutic series). Physico- and kinesitherapy can be distinguished with regard to objective and subjective doses; manual therapy is between them. ⋯ The problem "rheumatism and pain" mainly exists at the level of "chronic"; diagnostics of movement function (articular and muscular functions) on one hand and dosage of therapeutic remedies (drugs and remedies of physiotherapy) on the other are the guidelines. Course (rehabilitation) as well as onset (prevention) of rheumatic clinical pictures determine the further strategy of pain therapy.
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The use of implantable systems for intrathecal administration of opioids in chronic pain of non-malignant origin is a controversial subject. Opioid therapy is reserved mainly for pain patients with malignant disease and reduced life-expectancy. The main reasons for this restricted range of indications of chronic subarachnoid administration of opioids are fear of addiction and the build-up of tolerance. ⋯ It seems that neuropathic and deafferentation pain syndroms are susceptible to intrathecal opioids. The initial daily average dose of morphine was 2.6 mg/day, increasing to 6.1 mg/day after 25 months without the development of major tachyphylaxis. the administration of intrathecal opioids by means of implantable systems is justified in carefully selected patients with chronic non-malignant pain. This method should be applied in preference to destructive neurosurgical treatments.
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Psychodynamic concepts postulate a psychogenesis of physical pain proposing several assumptions about the conversion of mental suffering into physical pain. Behavioural concepts, on the other hand, emphasize psychological conditions as risk factors for chronicity and describe psychological reactions to chronic pain. Patients with painful diseases and inadequate coping strategies very often display symptoms of anger, anxiety, or depression. ⋯ Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.
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The documentation of illness-related data, e.g. repetitive recordings of pain parameters, medication or mood, is commonly accomplished by the use of questionnaires. Several disadvantages for both the patient and experimentor related to this method can be avoided by the application of specially designed data-loggers. The use of commercially available portable pocket computers is usually complicated because of the miniature full-range keybords. ⋯ Nine out of 12 patients preferred the Rating Box both methods were judged to be equivalent by two patients and only one regarded the use as difficult and thus preferred the questionnaire. In addition, 5 out of 12 patients confessed by inquiry to have filled in the questionnaire forms retrospectively. This possibility is in principle excluded by the Rating Box.
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Myofascial pain syndromes, fibromyalgia, and articular dysfunctions may all be contributing to our patients' ubiquitous musculoskeletal pain problems that generally are poorly understood and poorly managed. Thepectoralis minor myofascial pain syndrome, for example, results from trigger points (TrPs) activated by stress overload of the muscle. ⋯ Snapping palpation at the TrP elicits a local twitch response (LTR). The increased muscle tension of a pectoralis minor syndrome commonly entraps the lower trunk of the brachial plexus, producing symptoms of a cervical radiculopathy.