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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic low back pain is more significant from the psychiatric point of view than the acute pain. As a persistent pain of organic origin it leads to typical psychopathological symptoms ("algogenic psychosyndrome"). The algogenic psychosyndrome must be differentiated diagnostically from neurotic developments and masked depressions. Psychosomatic low back pain is a warning of failure in the accomplishment of professional or family duties and chronic and chronic inhibited aggression. - An interdisciplinary study of the courses of 50 patients operated on for prolapse of the lumbar intervertebral disk showed that the psychopathological picture and the pain syndrome are usually determined by several factors. The majority of neurotic disordered personalities developed symptoms of new syndromes after the operation.
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PMID:[Psychiatric aspects of low back pain (author's transl)]. 14 4

The effect of the presence of either chronic or acute clinical pain on pain threshold and on the nociceptive flexion reflex (RIII) threshold was studied. The experimental pain sensation and the flexion reflex were evoked by trains of short electrical pulses. It was hypothesized that both kinds of clinical pain would be able to induce 'diffuse noxious inhibitory controls' (DNIC) and thereby raise the 2 experimental thresholds. Patients with chronic low back pain, patients with postoperative pain from oral surgery, and pain-free subjects were tested in 3 conditions: during baseline, after i.v. administration of a placebo, and after i.v. administration of naloxone. In comparison with 2 pain-free control groups, the 2 pain groups had a significantly higher pain threshold in all conditions. However, the RIII threshold was not significantly elevated in chronic or acute pain patients compared to controls. Naloxone had no effect on the RIII or pain threshold in any of the groups. It is concluded that the increased pain threshold which is frequently found in chronic pain patients, and which could be confirmed in the present study, does not result from a DNIC effect. The adaptation level theory offers an alternative explanation. Also, the acute postoperative pain in this study did not seem to induce DNIC. Because other forms of acute pain have been found to be effective in activating DNIC, future research should establish which pains are and which pains are not effective.
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PMID:Chronic back pain, acute postoperative pain and the activation of diffuse noxious inhibitory controls (DNIC). 140 14

This chapter has reviewed research on psychological and social factors associated with the onset and progression of low back pain. From this review it can be concluded that psychosocial traits appear to be important contributors to the course of pain and disability though methodologically well-designed longitudinal studies are rare. For this reason it is difficult to assess the relative importance of, for example, psychological distress compared with work stress. Furthermore, the mechanisms by which specific variables effect back pain remain unknown. The answer, no doubt, lies in longitudinal studies which employ multicausal models. It has been noted the psychosocial treatments which have proven effective for chronic pain populations are rarely assessed with acute pain patients. Some problems are the inaccessibility of acute back pain sufferers to psychologists, the difficulty of isolating the effect of one component of a multidisciplinary programme and the lack of uniform practice of psychosocial techniques. None the less, programmes which include psychosocial interventions appear to have superior results to those which do not. Since these techniques are often simple and inexpensive to include they should be incorporated into all treatment programmes where the potential for chronic pain syndrome exists. Gaps and flaws in current research methodologies have been identified and suggestions for future investigations have been proposed. In addition we have attempted to provide some practical guidelines for health care professionals to help them identify salient psychosocial issues which may effect the course of their patient's treatment. Recommendations for assessment and referral are also provided.
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PMID:Psychosocial issues in the prevention of chronic low back pain--a literature review. 147 96

Ninety percent of all low back pain can be managed successfully by the skillful and appropriate use of the major analgesic drugs, NSAIDs, and the opioids. Adjunctive drugs, such as skeletal muscle relaxants and antidepressants, have their uses, but must be considered as temporary aids to the major analgesics. There is intensive research to develop new and more useful analgesic drugs. Ketorolac tromethamine, an NSAID recently approved by the Food and Drug Administration, is suitable for intramuscular administration for the short-term management of postsurgical and other acute pain.
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PMID:Management of low back pain by analgesics and adjuvant drugs. 183 Mar 65

Based on accumulating evidence, an important shift in the nonsurgical treatment paradigm for low back pain is underway. This shift is away from prolonged rest and passive therapy toward earlier patient activation and greater use of exercise therapy. The patient's best interest is often served by encouraging an early return to work and by avoiding adversarial legal proceedings. Patients should be reassured about the good prognosis of acute pain, and the alarming terminology of "injury" or "ruptured disc" should be avoided. Intervention to avoid sedentariness, smoking, and obesity probably offers important therapeutic and preventive opportunities. When surgery is indicated, the patient should have a major role in decision making after being provided an accurate view of risks and benefits of surgical intervention. Surgery should generally be reserved for those cases for which a benefit of surgery has been clearly established, avoiding the liberalization of indications to include imaging findings alone, persistent pain alone, or the failure of other treatments in the absence of clear surgical indications.
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PMID:Nonsurgical care of low back pain. 184 Mar 91

Previous research has shown an interaction between chronic and acute pain behavior. Chronic low back pain (CLBP) patients seem to have a higher pain perception threshold and a lower pain tolerance than pain-free controls. The major focus is, however, on another aspect of pain behavior: habituation of the pain response after repeated stimulation. Habituation of the pain perception threshold was found for control subjects but not for CLBP patients. Inability to habituate to pain may be regarded as a risk factor in the development of CLBP.
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PMID:Chronic low back pain and the reaction to repeated acute pain stimulation. 253 Apr 88

The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently.
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PMID:Persistence behavior of chronic low back pain patients in an acute pain situation. 294 81

Bed rest is usually recommended for acute low back pain. Although the optimal duration of bed rest is uncertain, a given prescription may directly affect the number of days lost from work or other activities. In a randomized trial, we compared the consequences of recommending two days of bed rest (Group I) with those of recommending seven days (Group II). The subjects were 203 walk-in patients with mechanical low back pain; 78 percent had acute pain (less than or equal to 30 days), and none had marked neurologic deficits. Follow-up data were obtained at three weeks (93 percent) and three months (88 percent). Although compliance with the recommendation of bed rest was variable, patients randomly assigned to Group I missed 45 percent fewer days of work than those assigned to Group II (3.1 vs. 5.6 days, P = 0.01), and no differences were observed in other functional, physiologic, or perceived outcomes. For many patients without neuromotor deficits, clinicians may be able to recommend two days of bed rest rather than longer periods, without any perceptible difference in clinical outcome. If widely applied, this policy might substantially reduce absenteeism from work and the resulting indirect costs of low back pain for both patients and employers.
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PMID:How many days of bed rest for acute low back pain? A randomized clinical trial. 294 9

Twenty-one chronic low back pain (CLBP) patients and 20 control subjects participated in 8 successive cold pressor tests (CPT). The hypotheses were that: (1) CLBP patients would demonstrate poorer acute pain tolerance and report higher acute pain, and (2) CLBP patients would become sensitized during 8 successive CPT trials, while control subjects would habituate, resulting in increasing differences in test behavior between both groups. The results show that the first hypothesis was confirmed. The second hypothesis requires modification, as the control group both habituated and became sensitized, while within the CLBP group no learning or training effect was found. These findings lead one to conclude that the deviant acute pain behavior of CLBP patient may be regarded either as a consequence of CLBP or as an important risk factor in the development of CLBP. Patients with relatively high CLBP levels performed poorly on the CPT as compared with patients with relatively low CLBP levels.
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PMID:Learning processes in the persistence behavior of chronic low back pain patients with repeated acute pain stimulation. 295 99

Spinal manipulative therapy is one of the most commonly used treatments for patients with low back pain. It is both a manual diagnostic and a treatment method. Manual diagnosis includes the palpation of vertebral position, vertebral motion, joint play, end feel, soft tissue texture changes, and muscle contracture. Manipulative treatment can be divided into seven categories: long-lever, nonspecific manipulation; specific, short-lever high-velocity spinal adjustments; active or functional manipulation; mobilization; manual traction; soft tissue massage; and point pressure manipulation. Clinical experience with manipulation for low back pain is extensive, and controlled observations show that it is possible to produce immediate relief of pain in some cases. The effectiveness of manipulation is greatest in patients who have acute pain and no leg pain or neurologic deficits. Long-term effects of manipulation have not been demonstrated. Manipulation appears to increase spinal range of motion and straight leg raising but is not known to reduce intervertebral disc herniations. Complications following manipulation, although rare, can be catastrophic.
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PMID:Spinal manipulative therapy. A status report. 622 97


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