scholarly journals Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients’ Perspective

2020 ◽  
Vol 9 (1) ◽  
pp. 145 ◽  
Author(s):  
Timo A. Nees ◽  
Ernst Riewe ◽  
Daniela Waschke ◽  
Marcus Schiltenwolf ◽  
Eva Neubauer ◽  
...  
Keyword(s):  
Medical Training ◽  
Chronic Back Pain ◽  
Treatment Modalities ◽  
Psychological Pain ◽  
Aquatic Therapy ◽  
Psychological Pain Therapy ◽  
Multidisciplinary Pain Management ◽  
Back Education ◽  
Perceived Helpfulness ◽  
Training Therapy

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients’ perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients’ perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient’s perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients’ perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22–64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1–6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients’ perceived treatment helpfulness. In conclusion, patients’ perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

scholarly journals The best from East and West? Acupuncture and medical training therapy as monotherapies or in combination for adult patients with episodic and chronic tension-type headache: study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
J. Schiller ◽  
T. Kellner ◽  
J. Briest ◽  
K. Hoepner ◽  
A. Woyciechowski ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Medical Training ◽  
Controlled Trial ◽  
Health Intervention ◽  
University Hospital ◽  
Acupuncture Points ◽  
Randomized Controlled ◽  
Tension Type Headaches ◽  
And Training ◽  
Training Therapy

Abstract Background This study aims to evaluate the feasibility and efficacy of a complex health intervention, based on the combination of conventional Western medicine and traditional Chinese medicine (TCM), in an outpatient department of a university hospital for patients with frequent episodic or chronic tension-type headaches. Methods/design This is a prospective randomized controlled pilot study with four balanced treatment arms (usual care, acupuncture, training, and training plus acupuncture). Each arm will have 24 patients. After the initial screening examination and randomization, a 6-week treatment period follows, with treatment frequencies decreasing at 2-week intervals. After completion of the intervention, two follow-up evaluations will be performed 3 and 6 months after the start of treatment. At predefined times, the various outcomes (pain intensity, health-related quality of life, pain duration, autonomic regulation, and heart rate variability) as well as the participants’ acceptance of the complex treatment will be evaluated with valid assessment instruments (Migraine Disability Assessment, PHQ-D, GAD-7, and SF-12) and a headache diary. The acupuncture treatment will be based on the rules of TCM, comprising a standardized combination of acupuncture points and additional points selected according to individual pain localization. The training therapy comprises a combination of strength training, endurance training, and training to improve flexibility and coordination. Besides descriptive analyses of the samples, their comparability will be assessed using an analysis of variance (ANOVA) or chi-squared tests. Analyses will be performed on an intention-to-treat basis. Potential interaction effects will be calculated using a repeated-measures ANOVA to test the primary and secondary hypotheses. In supplementary analyses, the proportion of treatment responders (those with a 50% reduction in the frequency of pain episodes) will be determined for each treatment arm. Discussion This trial may provide evidence for the additive effects of acupuncture and medical training therapy as a combination treatment and may scientifically support the implementation of this complex health intervention. Trial registration Registered on 11 Feburary 2019. German Clinical Trials Register, DRKS00016723.

Medical training therapy in lumbar syndromes

1999 ◽  
Vol 28 (11) ◽  
pp. 932-938
Author(s):  
E. Broll-Zeitvogel ◽  
J. Grifka ◽  
J. Bauer ◽  
P. H. Roths ◽  
P. Degryse
Keyword(s):  
Medical Training ◽  
Training Therapy

Konservative Hämophiliebehandlung unter Berücksichtigung der Optimierung und Standardisierung

2010 ◽  
Vol 30 (S 01) ◽  
pp. S81-S88 ◽  
Author(s):  
T. Wallny ◽  
A. Kurth ◽  
P. Berdel ◽  
A. Seuser
Keyword(s):  
Physical Therapy ◽  
Medical Training ◽  
The Body ◽  
Biofeedback Training ◽  
System Stability ◽  
Functional Health ◽  
Motion Pattern ◽  
Joint Function ◽  
Functional Therapy ◽  
Training Therapy

SummaryRehabilitation and physical therapy in the sense of functional health is based on the international classification of function. It takes in two considerations: function and structure of the body and their influence on personal and social activity. The integrative concept of joint function translates the basic concept of body function and structure on to the motion of the locomotive system. Stability needs motoric control. Motoric control and the integrated neural components are to be influenced through regulation of muscle tonus (massage, manual therapy, medical training therapy, electrotherapy and thermotherapy). The stability of the joint is controlled by the passive components. Passive structures are optimised through passive therapies like joint mobilisation. Active components of joint function are optimised through activation (medical training therapy, stabilisation, mono or multisegmental levels). Emotional and neuronal components can be triggered through kinesthetic exercises like PNF, Jacobsen relaxation, biofeedback training, mental training. Exact examination of the locomotive system will help finding all symptoms. This is how we individualise the therapy of symptoms and structures. The motion pattern generator shows us how to use the possibilities of functional influence on the motion pattern. We have a lot of afferent signals that need individualised functional therapy. This is why we need functional measurements like motion analysis on the basis of ultrasound. An other tool is the kinetic superficial EMG measurement of muscle function. We can use it to determine the status of the joint and it will lead to therapeutical decisions. All functional measurements will help to improve quality control of the physical therapy process. Even if the haemophilic patient is healthy he is not fit at all. Measurements of fitness will help us to improve special skills and establish the human being as a subject in society and environment. The main skill to be improved in haemophiliacs is coordination, strength of the stomach muscles and the vastus medialis and the flexibility of the hamstrings.

Medical training therapy (MTT)

2001 ◽  
Vol 58 (8) ◽  
pp. 470-474
Author(s):  
Haiko Sprott ◽  
K. Wagner ◽  
D. Uebelhart
Keyword(s):  
Medical Training ◽  
Evidence Based ◽  
Training Therapy

Die medizinische Trainingstherapie (MTT) ist eine der aktiven physiotherapeutischen Maßnahmen, die ärztlich verordnet werden können. Diese aktive Bewegungstherapie wurde durch O. Holten in Norwegen entwickelt und hat seitdem viele Therapeuten und Patienten begeistert. Sie wird deswegen mehr und mehr verordnet und hat nach und nach einen Teil der passiven physiotherapeutischen Maßnahmen ersetzt. Die Ziele der MTT sind die Verbesserung der Ausdauer und der Kraft, sowie der Beweglichkeit der Gelenke im schmerzfreien Rahmen. Die MTT hat keine absoluten Kontraindikationen, aber muss in jedem Fall individuell angepasst sein. Ein wesentlicher Vorteil der Methode gegenüber Einzelbehandlungen liegt in der Möglichkeit begründet, dass die Trainingstherapie in kleinen Gruppen kontrolliert durchgeführt werden kann. Wie auch bei anderen physiotherapeutischen Methoden sollte die MTT im Rahmen wissenschaftlicher Studien evaluiert werden, um ihre Evidence-based Effizienz bestätigen zu können.

Understanding Barriers to Emergency Care in Low-Income Countries: View from the Front Line

2007 ◽  
Vol 22 (5) ◽  
pp. 467-470 ◽  
Author(s):  
Adam C. Levine ◽  
David Z. Presser ◽  
Stephanie Rosborough ◽  
Tedros A. Ghebreyesus ◽  
Mark A. Davis
Keyword(s):  
Emergency Care ◽  
Low Income ◽  
Medical Training ◽  
Network Capacity ◽  
Low Income Countries ◽  
Treatment Modalities ◽  
Health Providers ◽  
Convenience Sample ◽  
Major Barrier ◽  
Emergency Medical

AbstractIntroduction:Morbidity and mortality due to acute but treatable conditions remain high in the developing world, as many significant barriers exist to providing emergency medical care.This study investigates these barriers in a rural region of Ethiopia.Hypothesis:The limited capacity of frontline healthcare workers to diagnose and treat acute medical and surgical conditions represents a major barrier to the provision of emergency care in rural Ethiopia.Methods:Health providers at a convenience sample of 16 rural health centers in the state of Tigray, Ethiopia completed a questionnaire designed to assess the availability of diagnostic and treatment modalities, the proximity and methods of transportation to referral facilities, and health providers' level of comfort in diagnosing and treating a variety of representative emergency medical conditions.Results:Thirteen (81%) providers had only a very basic level of medical training, and seven (44%) lacked access to any diagnostic equipment.While most providers could offer oral rehydration solution (ORS), anti-pyretic medications, and antibiotics, none of the providers could offer blood transfusions or any form of surgery. Ten (63%) respondents stated that their patients had to travel >10 km from the health center to a referral hospital, with only a minority of patients having access to motorized transport. For the seven emergency conditions assessed, a majority of providers felt comfortable diagnosing these conditions, though fewer felt comfortable treating them.Conclusion:There is a significant need for both health worker training and improvements in transportation infrastructure in order to increase access to emergency medical care in rural areas of the developing world.Low-cost interventions that improve human capacity in a context-appropriate manner are warranted as transportation and hospital network capacity expansions are considered.

scholarly journals For whom the disc tolls: intervertebral disc degeneration, back pain and toll-like receptors

2021 ◽  
Vol 41 ◽  
pp. 355-369
Author(s):  
DG Bisson ◽  
◽  
M Mannarino ◽  
R Racine ◽  
L Haglund
Keyword(s):  
Back Pain ◽  
Intervertebral Disc ◽  
Inflammatory Cytokines ◽  
Chronic Back Pain ◽  
Proteolytic Enzymes ◽  
Treatment Modalities ◽  
Toll Like Receptors ◽  
Disc Cells ◽  
Ivd Degeneration ◽  
Pro Inflammatory Cytokines

Intervertebral disc (IVD) degeneration is characterised by catabolic and inflammatory processes that contribute largely to tissue degradation and chronic back pain. The disc cells are responsible for the pathological production of pro-inflammatory cytokines and catabolic enzymes leading to degeneration. However, this phenotypical change is poorly understood. Growing evidence in animal and human studies implicates Toll-like receptors (TLR) and their activation through danger-associated alarmins, found increasingly in degenerating IVDs. TLR signalling results in the release of pro-inflammatory cytokines and proteolytic enzymes that can directly cause IVD degeneration and back pain. This review aims to summarise the current literature on TLR activation in IVD degeneration and discuss potential treatment modalities to alleviate the inflammatory phenotype of disc cells in order to arrest IVD degeneration and back pain.

scholarly journals The evaluation of the relevance of teaching of homeopathy at the medical school

2021 ◽  
Vol 10 (36) ◽  
pp. 286-288
Author(s):  
Francisco José de Freitas ◽  
Debora Alves dos Santos Fernandes
Keyword(s):  
Undergraduate Students ◽  
Rio De Janeiro ◽  
Medical Training ◽  
Medical Curriculum ◽  
Opportunity To Learn ◽  
Medical Specialty ◽  
Medical Faculty ◽  
The State ◽  
Treatment Modalities ◽  
Prospective Longitudinal

Background: In 1912 the Hahnemann Medical Faculty to graduate homeopathic physicians was created. This was one of the courses that originated the present Federal University of the State of Rio de Janeiro – UNIRIO. Homeopathy in UNIRIO was consolidated during the 80s and 90s through the relationship with other specialties. In 1999, the interface of Homeopathy and the curriculum guidelines of the Brazilian Ministry of Education justified the inclusion of Homeopathy as a compulsory subject in the medical course at UNIRIO. In 2001 a University program to improve the development of research called “Homeopathy - Health and Quality of Life”, was created to integrate the activities of Teaching, Research and Extension. Aim: To evaluate the relevance of the compulsory teaching of Homeopathy in the medical area at the Federal University of the State of Rio de Janeiro – UNIRIO, Brazil. Methods: A prospective longitudinal qualitative and quantitative research was used with semi-structured questionnaires with open and closed questions at the beginning and end of each semester. Undergraduate students from the third year of the UNIRIO Medical Faculty (2008/March till 2009/September) who accepted the “Consent Form”, were included. Students who didn't respond adequately to the questions were excluded. This research was approved and registered at the Brazilian Research Ethics Center. Microsoft Office Excel 2007 used to data collection and analysis. Results: Total number of students attending the course during the four semesters: 304. 70% answered the questionnaires. 60% of the students had heard of homeopathy before attending the homeopathy course (67% as patients, 21% as patients and through media, 6% through media and 6% by other means of contact). 86% consider that homeopathy brought new knowledge to the medical and academic training. 72% consider that this knowledge could be applicable to their future career. Conclusion: Most students aim to learn the guiding principles of homeopathy. Their aim is to know all available treatment, modalities and alternatives to allopathy in medical education. They considered that the learning of Homeopathy is a part of general medical training due to the fact that it has been a recognized medical specialty in Brazil since 1980. The student’s opportunity to learn homeopathy during the undergraduate course in medical schools widens the individuality concept, “the doctor-patient relationship and the holistic vision of the patient”. These results demonstrate the relevance of teaching homeopathy in the medical curriculum and the need to spread the teaching of homeopathy as a compulsory course for all other medical universities.

Should Multidisciplinary Pain Management Programmes Attempt to Reduce Self-Reported Pain in Patients with Chronic Back Pain? The Experience of a Welsh Inpatient Unit

1996 ◽  
Vol 59 (9) ◽  
pp. 411-414 ◽  
Author(s):  
Mary Gough ◽  
Michael Frost
Keyword(s):  
Pain Management ◽  
Chronic Back Pain ◽  
Management Programme ◽  
Survey Questionnaire ◽  
Methodological Problems ◽  
Poor Outcomes ◽  
One Year ◽  
Multidisciplinary Pain Management

Given poor outcomes in pain reduction, It has recently been recommended in this Journal that the primary aim of multidisciplinary pain management programmes should be to improve physical functioning rather than attempting to reduce the experience of pain. This study evaluates the effectiveness of a pain management programme in reducing self-reported pain within the overall context of improvements in quality of life, as assessed by the SF36 Health Survey Questionnaire. Logistical and methodological problems in evaluating self-reported pain are discussed. The results at discharge show a statistically significant reduction in reported pain for the group as a whole and a clinically relevant Improvement in 53.8% of patients. These benefits are maintained up to one-year follow-up, which suggests that pain management programmes should not abandon the attempt to reduce self-reported pain.

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