1/106. The power of the visible: the meaning of diagnostic tests in chronic back pain.This article explores the meaning of diagnostic tests for people with chronic back pain. Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provider for back pain ultimately develop a chronic condition. We draw on interviews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of concern for patients: a strong historical connection between visual images and the medicalization of the interior of the body, a set of cultural assumptions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. Our interviews show that when physicians cannot locate the problem or express doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of the visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the symbolic world of medicine. This paper concludes by suggesting that a fluid, less localized understanding of pain could provide a greater sense of legitimacy for back pain patients.- - - - - - - - - - ranking = 1keywords = pain, back pain, back (Clic here for more details about this article) |
2/106. Why is chronic pain so difficult to treat? Psychological considerations from simple to complex care.The treatment of patients with chronic pain can be difficult and challenging. Recent advances in our understanding of the pathophysiologic mechanisms involved have led to viewing this condition as a multifactorial problem with interrelated structural, functional, and psychophysiologic factors. Treatment of simple chronic pain is fundamentally different from that of complex chronic pain. The former can be managed by one clinician alone, whereas the latter requires the integration of a multidisciplinary team of specialists with a biopsychosocial treatment philosophy.- - - - - - - - - - ranking = 0.4019466667812keywords = pain (Clic here for more details about this article) |
3/106. work-related posttraumatic upper limb disorder. A case report.In this paper we describe a patient with mor-sensory loss in the right forearm and hand, which persisted more than 2 years after work-related crush trauma of the left hand. Radiographic and electromyographic investigations, somatosensory evoked potentials, CT scans of the encephalus as well as the minnesota Multiphasic personality inventory and the Roarschach test have been performed. On the basis of these investigations, we think this represents a case of conversion disorder with somatic features. Included is a brief overview of other psychological illness with physical findings involving the upper limb.- - - - - - - - - - ranking = 0.0048850714286184keywords = upper (Clic here for more details about this article) |
4/106. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 0.74647238116509keywords = pain (Clic here for more details about this article) |
5/106. chronic pain as a posture towards the world.This article discusses what chronic pain is "about", what the intentional object is of pain, and what is the intentional relation like? My approach is based on Maurice Merleau-Ponty's phenomenology, with an aim is to understand a two-way relationship: how the sufferers bestow meaning on chronic pain, and how pain, on the other hand, signifies peoples' life. In contrast to biomedical and cognitive-behavioral theories, chronic pain is not only meaningful, but as an intentional emotion as well; it does not simply "happen" in the nervous system. I analyzed meanings assigned to pain through the narratives of three patients with chronic pain. Pain is described as creating a discontinuity in the patient's Lebenswelt at the narrative level. When attempting to find meaning to their pain, patients point both to everyday life and biomedical referents. The structure of bestowing meaning is, metaphorically, like a necklace with everyday world and biomedical interpretations strung like beads, one after the other. The intentional object of pain, on the contrary, is constituted of the patients' world in its wholeness. My results don't confirm Drew Leder's idea of disrupted intentionality, but underline directness as the basic relation of human experience also in case of pain and disease. Pain in itself is an e-movere, an intense passionate movement, an intentional relation with and a bodily posture taken towards the world.- - - - - - - - - - ranking = 0.8038933335624keywords = pain (Clic here for more details about this article) |
6/106. Psychosomatic disorders in pediatrics.Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Common symptoms seen in pediatric age group include abdominal pain, headaches, chest pain, fatigue, limb pain, back pain, worry about health and difficulty breathing. These, more frequently seen symptoms should be differentiated from somatoform or neurotic disorders seen mainly in adults. The prevalence of psychosomatic complaints in children and adolescents has been reported to be between 10 and 25%. These symptoms are theorized to be a response to stress. Potential sources of stress in children and adolescents include schoolwork, family problems, peer pressure, chronic disease or disability in parents, family moves, psychiatric disorder in parents and poor coping abilities. Characteristics that favour psychosomatic basis for symptoms include vagueness of symptoms, varying intensity, inconsistent nature and pattern of symptoms, presence of multiple symptoms at the same time, chronic course with apparent good health, delay in seeking medical care, and lack of concern on the part of the patient. A thorough medical and psychosocial history and physical examination are the most valuable aspects of diagnostic evaluation. Organic etiology for the symptoms must be ruled out. Appropriate mental health consultation should be considered for further evaluation and treatment.- - - - - - - - - - ranking = 0.26574222712537keywords = pain, back pain, headache, back (Clic here for more details about this article) |
7/106. A case study of neurosis secondary to trauma in an eight-year-old girl. Comments on the tendency for psychogenic illness to become chronic.This case study deals with an eight-year-old girl who developed persistent abdominal pain and vomiting for which no physiological cause could be discovered. After two months of unsuccessful treatment for her illness, the girl was referred for a psychiatric consultation. During the psychiatric interview, the psychogenic nature of the girl's illness became readily apparent, as did the nature of the conflict which had produced it. The tendency is strong for psychogenic illness, such as this, to become chronic without psychiatric treatment. Many physicians are reluctant to apply clinically basic psychiatric techniques to the treatment of physical illness. A suggestion is made that closer collaboration between psychiatry and other medical specialties could be of great value in preventive medicine.- - - - - - - - - - ranking = 0.064487655300319keywords = pain, abdominal pain (Clic here for more details about this article) |
8/106. Psychogenic paraplegia in a patient with normal electrophysiologic findings.STUDY DESIGN: A case report of psychogenic paraplegia following a motor vehicle accident was clinically diagnosed using median (MN) and posterior tibial nerves (PTN) somatosensory evoked potentials (SSEPs). OBJECTIVE: To report an unusual case of paraplegia in spite of normal electrophysiological and non-compromising radiographic spine findings. SUMMARY OF BACKGROUND DATA: conversion disorder with motor system symptoms or deficit is a subtype which includes symptoms such as impaired motor coordination or balance, paraplegia, muscle weakness, difficulty in swallowing, and urinary retention. methods: The SSEPs were performed by each PTN at the ankle region behind the medial malleolus or the MN at the wrist using square wave pulses in 15 mA intensity. The SSEPs revealed well-developed somatosensory peaks for all extremities. RESULTS: Well-resolved MN-SSEPs were seen with stimulation of either arm. The principal peaks of N20 and P22 were 17 and 21 ms for both upper extremities. The principal peaks of P37 and N45 were 35 and 46 ms for both lower extremities. No side-to-side latency difference was noted. The MRI scan finding was a non-displaced L1 fracture without spinal canal compromise. CONCLUSIONS: In spite of an apparent paraplegia, contradictory clinical findings, normal neurophysiologic tests, and normal neuroradiologic findings are positive criteria for paraplegia/quadriplegia with psychogenic etiology.- - - - - - - - - - ranking = 0.00097701428572369keywords = upper (Clic here for more details about this article) |
9/106. Growing pains: fact or fiction?Growing pains are recurrent limb pains peculiar to children. Brief episodes of leg pains occurring intermittently at night are typical, but the clinical spectrum is variable. A diagnosis of growing pains can be made with certainty only after other possible conditions have been ruled out by appropriate studies and after the child has been observed carefully for a period of months. The two diseases most often confused with this syndrome are rheumatic fever and juvenile rheumatoid arthritis. aspirin and supportive measures are beneficial.- - - - - - - - - - ranking = 0.45936761917852keywords = pain (Clic here for more details about this article) |
10/106. Orgone (Reichian) therapy in tension headache.Orgone (Reichian) therapy, which utilizes a unique physical approach in addition to standard character-analysis, is illustrated in cases of muscle contraction (tension) headache. It offers a more direct technique for attacking the muscular tension (somatic armor) while undermining the psychic defenses.- - - - - - - - - - ranking = 0.039443410550068keywords = headache (Clic here for more details about this article) |
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