1/49. 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 = medicine (Clic here for more details about this article) |
2/49. Treatment planning in pain medicine. Integrating medical, physical, and behavioral therapies.This article addresses a systematic approach to the treatment of chronic pain. The first section presents a biopsychosocial model of pain. The second section presents an application of the biopsychosocial approach to the clinical assessment and management of clinical cases with chronic pain.- - - - - - - - - - ranking = 4keywords = medicine (Clic here for more details about this article) |
3/49. Improvements in chronic diseases with a comprehensive natural medicine approach: a review and case series.Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multimodality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson's disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.- - - - - - - - - - ranking = 6keywords = medicine (Clic here for more details about this article) |
4/49. Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report.BACKGROUND: Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus. A multispecialty approach and alternative medicine are often effective. Recently, the FDA announced the use of acupuncture and acupressure as officially recognized modalities for treatment of chronic pain in oncology patients. CASE: Chronic pelvic pain in a 23 year-old primigravida at 27 weeks' gestation was incapacitating on narcotics. After organic causes were ruled out, acupuncture was employed successfully. Outpatient management for the duration of the pregnancy included acupuncture and narcotics for breakthrough pain while maintaining activities of daily living. Spontaneous vaginal delivery without complications at 38 5/7 weeks produced a 3,305-g female infant. The pain resolved immediately following delivery. CONCLUSION: This case demonstrates the benefit of combined allopathic with alternative forms of medicine. With the use of acupuncture, narcotic use was limited in this gravida while adding to her quality of life by allowing her to maintain normal activity.- - - - - - - - - - ranking = 2keywords = medicine (Clic here for more details about this article) |
5/49. 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 = 1keywords = medicine (Clic here for more details about this article) |
6/49. Nonpharmacologic treatments in psychodermatology.The author believes that psychocutaneous medicine has indeed come of age and is being incorporated into mainstream medical practice. patients presenting to dermatologists today are more sophisticated and are frequently dissatisfied with traditional medical therapies. They actively seek alternative approaches and adjuncts to standard treatments. In contrast to many other "alternative" (or) "holistic" treatments offered through non-medical venues, dermatologists can assure their patients that controlled studies support the efficacy of psychocutaneous techniques in improving many dermatologic conditions. psoriasis, rosacea, herpes simplex, body dysmorphic disorder, acne, eczema, urticaria, neurotic excoriations, excoriated acne, trichotillomania, dysesthetic syndromes, and delusions parasitosis are included in this incomplete list. The author believes it is helpful for both the patient and therapist to define concrete and realistic goals for psychocutaneous intervention. Concrete observable or measurable goals can help the patient and clinician gauge therapeutic progress and success. Specifically, goals can include reduction in pruritus (rating severity from 1-10), decreased scratching activity, decreased plaque extent or thickness, decreased number of urticarial plaques, decreased flushing, decreased anxiety, decreased anger, decreased social embarrassment, decreased social withdrawal, and improved sleep. More global goals can include an improved sense of well-being, increased sense of control, and enhanced acceptance of some of the inevitable aspects of a given skin disease. Cure should never be a goal, because most disorders amenable to psychocutaneous techniques are chronic in nature; thus, cure as an endpoint would only lead to disappointment. The author encourages dermatologists to align themselves with what he euphemistically calls "a skin-emotion specialist." The skin-emotion specialist may be a psychiatrist, psychologist, social worker, biofeedback therapist, or other mental health or behavioral specialist. patients are more likely to accept a referral to a "skin-emotion specialist," because this term destigmatizes psychologic interventions. Incorporating these techniques and specialists into a clinical practice will expand therapeutic horizons and improve the quality of life of many of the patients afflicted with chronic skin disease. A final caveat must be offered about attempting to make prognostic statements regarding the likelihood of therapeutic success. Although all patients can potentially benefit from psychocutaneous interventions, those with severe psychopathology and poor pretreatment functional status are likely to be more difficult to treat and to achieve less optimal outcomes. patients with personality disorders such as borderline, narcissistic, and schizotypal disorders, and patients with any active psychotic process certainly constitute a more resistant and difficult population with whom therapeutic success is less likely. These patients, however, are often the ones in the greatest subjective distress and certainly can profit from any of the described interventions. Quoting W. Mitchell Sams, Jr., "although the physician is a scientist and clinician, he or she is and must be something more. A doctor is a caretaker of the patient's person--a professional advisor, guiding the patient through some of life's most difficult journeys. Only the clergy share this responsibility with us." This commitment is and must always be the guiding force in the provision of comprehensive and compatient patient care.- - - - - - - - - - ranking = 1keywords = medicine (Clic here for more details about this article) |
7/49. Chronic demyelinating polyneuropathy in graft-versus-host disease following allogeneic bone marrow transplantation.In recent years a novel problem has arisen in organ transplantation medicine, namely GVHD. The nervous system has been involved mainly at the level of the CNS and this can lead to a serious outcome for the patient. In rare cases, peripheral nerves may be affected and show acute or chronic polyneuropathy. Here a case is reported of polyneuropathy associated with chronic GVHD. A 32-year-old man, suffering from chronic GVHD following an allogeneic bone marrow transplantation (BMT) for malignant lymphoma at the age of 25, developed a motor dominant polyneuropathy 5 years later. Electrophysiologic studies demonstrated the demyelinating type of polyneuropathy. biopsy specimens from skin and skeletal muscle disclosed perivascular lymphocytic infiltrates expressing T-cell markers. The sural nerve showed a loss of myelinated nerve fibers with epineurial fibrosis and rare occurrence of T cells, but without obvious vasculitic changes. The present case suggested that polyneuropathy could develop in association with chronic GVHD in some patients with a long-standing disease course.- - - - - - - - - - ranking = 1keywords = medicine (Clic here for more details about this article) |
8/49. arsenic poisoning in a family.A family of six members is reported, who accidently consumed arsenic, during preparation of indigenous medicine in their home, and developed arsenic poisoning.- - - - - - - - - - ranking = 1keywords = medicine (Clic here for more details about this article) |
9/49. emergency medicine bedside ultrasound diagnosis of intussusception in a patient with chronic abdominal pain and unrecognized peutz-jeghers syndrome.An adult patient presented to the Emergency Department (ED) with abdominal pain caused by intussusception. The diagnosis had not been made despite several prior evaluations for episodes of similar symptoms. The diagnosis was finally made by bedside ultrasound performed by the treating physicians in the ED. The patient's underlying condition of peutz-jeghers syndrome with intestinal polyps was also previously undiagnosed. The discussion reviews and compares clinical aspects of intussusception in adults and children. Sonographic findings of intussusception and their pathological basis are described, and the accuracy of sonography in the diagnosis of intussusception is reviewed.- - - - - - - - - - ranking = 4keywords = medicine (Clic here for more details about this article) |
10/49. Perispinal TNF-alpha inhibition for discogenic pain.OBJECTIVE: To examine the potential of etanercept, a biological inhibitor of tumour necrosis factor-alpha (TNF), delivered by perispinal administration, for the treatment of pain associated with intervertebral disc disease. methods: charts from 20 selected patients treated at our private clinic by perispinal delivery of etanercept 25 mg for severe, chronic, treatment-resistant discogenic pain were reviewed. Therapeutic benefit was assessed clinically and was documented by changes in a validated pain instrument, the Oswestry Disability Index. The patients were treated off-label with etanercept as part of our usual practice of medicine. Five detailed case reports are presented, including three additional patients. RESULTS: Rapid, substantial and sustained clinical pain reduction was documented in this selected group of patients. The cohort of 20 patients had a mean age of 56.5 and mean duration of pain of 116 months. Nine of the patients had undergone previous spinal surgery; 17 had received an epidural steroid injection or injections (mean 3.2). This group of patients received a mean of 1.8 doses (range 1-5, median 1.0) of etanercept during the observation period. The mean length of follow-up was 230 days. Clinical improvement was confirmed by a decrease in the calculated Oswestry Disability Index from a mean of 54.85 /- 12.5 at baseline, improving to 17.2 /- 15.3 (p <0.003) at 24 days and ending at 9.8 /- 13 (p <0.003) at 230 days. CONCLUSIONS: TNF inhibition by etanercept delivered by perispinal administration may offer clinical benefit for patients with chronic, treatment-resistant discogenic pain. Further study of this new treatment modality is warranted.- - - - - - - - - - ranking = 1keywords = medicine (Clic here for more details about this article) |
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