RESUMEN
BACKGROUND: Multimodal pain therapy programs are increasingly being recommended as an effective treatment option also for elderly patients with chronic pain. However, data from Germany are limited. PATIENTS AND METHODS: A multimodal group program adapted to the specific needs of elderly pain patients over 70 years old (20 treatment days, over 10 weeks) was started in our pain clinic in June 2005. We evaluated clinical, psychometric and physical data at the beginning and at the end of the treatment program, and compared outcome results with a waiting list control group. RESULTS: A total of 24 patients (mean age 76.2+/-4.79 years) could be evaluated of which 21 patients suffered from musculoskeletal pain, 2 from neuropathic pain syndromes and 1 from headache. In the waiting-list control group 13 patients were included. There were no significant between-group differences regarding age, stages of chronification, pain intensity, duration of pain and pain diagnosis. CONCLUSIONS: A multimodal pain therapy program for elderly patients (over 70 years old) is an effective treatment option to reduce pain intensity and pain disability. Furthermore, life quality and physical performance improved. Long-term effects still have to be evaluated.
Asunto(s)
Terapia por Ejercicio , Dolor/rehabilitación , Modalidades de Fisioterapia , Psicoterapia de Grupo , Anciano , Enfermedad Crónica , Terapia Combinada , Femenino , Alemania , Humanos , Masculino , Dolor/psicología , Clínicas de Dolor , Dimensión del Dolor , Educación del Paciente como Asunto , Terapia por Relajación , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of the study was to investigate the effects of acupuncture on the affective and sensory experience of pain in chronic pain patients. Furthermore, the study tried to estimate the therapeutical benefit of acupuncture in relation to the stage of chronic pain according to the Mainz pain staging system for chronic pain (MPSS). METHODS: Patients with chronic pain syndromes who received acupuncture treatment answered a standardized pain questionnaire before and after treatment. The questionnaire included the visual-analogue-scale for the intensity of pain, the pain perception scale for the assessment of affective and sensory components of pain perception, and addressed the patients to the three stages of chronic pain (MPSS). RESULTS: From April 1997 to October 1999, patients (n = 165) suffering from chronic headache and facial pain syndromes (23%), spine associated pain syndromes (48%) or other pain conditions (29%) were subsequently included. Treatment with acupuncture showed a more pronounced reduction of the affective assessment than of the sensory assessment of pain. These effects were particularly pronounced in patients assigned to stage 3 of chronic pain (MPSS). CONCLUSIONS: Acupuncture in patients with high-stage chronic pain syndromes preferentially influences the affective dimension of pain perception. For the estimation of the overall clinical outcome of acupuncture treatment, a differentiation between affective and sensory components of pain is recommended.
Asunto(s)
Analgesia por Acupuntura , Manejo del Dolor , Dolor/fisiopatología , Afecto , Enfermedad Crónica , Humanos , Dimensión del Dolor , Sensación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Baseline data from the European Lacidipine Study on Atherosclerosis (ELSA) have shown that carotid intima-media thickness (IMT) is not related to diastolic blood pressure (BP), but that it is related to clinic systolic (S) or pulse pressure (PP) and more so to their 24 h average values. The aim of the present study was to determine whether IMT independently relates to additional information obtained through ambulatory BP, in particular to SBP or PP variability. METHODS AND RESULTS: In 1663 hypertensive patients, after a wash-out period from antihypertensive treatment (mean age 56.2 +/- 7.65 years), IMT was assessed from 12 different carotid sites. Ambulatory BP measurements were performed every 15 min (day) and every 20 min (night). IMT values were positively related to 24 h, day and night average SBP and PP. There was some relationship of IMT with day-night or clinic-day SBP and PP differences. The most important finding, however, was that IMT values were related with 24 h SBP or PP standard deviation (P < 0.001), a measure of overall SBP or PP variability. The relationship was seen also by multiple regression analysis, the standard deviation for SBP or PP only following age and 24 h average SBP or PP in accounting for IMT values. CONCLUSIONS: This is the first demonstration from a large database that not only average 24 h PP and SBP values, but also 24 h BP fluctuations, are associated with, and possibly determinants of, the alterations of large artery structure in hypertension.
Asunto(s)
Antihipertensivos/uso terapéutico , Arteriosclerosis/tratamiento farmacológico , Presión Sanguínea , Arterias Carótidas/diagnóstico por imagen , Dihidropiridinas/uso terapéutico , Hipertensión/diagnóstico por imagen , Hipertensión/fisiopatología , Anciano , Estudios Transversales , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Pulso Arterial , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , UltrasonografíaRESUMEN
This study was carried out to evaluate the internal exposure to polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/PCDFs) of chimney sweeps in Bavaria compared to a control group without occupational exposure. The PCDD/PCDF concentrations in the blood fat of 227 chimney sweeps were compared with the concentrations in samples from 60 controls. Using an internal standard containing 17 (13)C(12)-labeled PCDD/F congeners, the samples were cleaned up after fat elution using standard methods. The statistical analysis was adjusted to account for demographic differences, dietary habits, smoking status, and both occupational and nonoccupational contact with chlorinated hydrocarbons. Detailed information on the type of heating in the households swept, the length of time the chimney sweeps had carried out the profession (min 34, med 195, max 466 months) and the protective measures employed, were used to examine the influence of the working conditions specific to chimney sweeps on the internal PCDD/PCDF exposure. The correlation between blood-fat PCB concentrations as well as urinary chlorophenol concentrations and the exposure to PCDDs/PCDFs was evaluated. The sum of PCDD/PCDF components in chimney sweeps, expressed by International Toxic Equivalents (I-TEQ), was significantly increased compared to the control group (median: 26.36 versus 20.75 pg I-TEQ/g blood fat). For 37 chimney sweeps (16.3%) the sum of PCDDs/PCDFs exceeded the 95th percentile of the control group, i.e., 38.23 pg I-TEQ/g blood fat. Multiple regression analysis revealed that in addition to occupation, the variables age, district, and proximity to a waste incineration plant seem to have an effect on the internal PCDD/PCDF exposure. An additional influence on the internal exposure could not be determined for any of the special aspects of the work. We identified no high correlations between the concentrations of PCBs and chlorophenols and PCDDs/PCDFs. This study revealed significantly higher internal exposure to PCDDs/PCDFs in chimney sweeps than in the control group. The differences are small and within the range of the internal exposure to PCDDs/PCDFs in blood found in the general population in Germany since 1989. Further investigations in to PCDD/PCDF-related diseases in these study groups were not carried out.