Résumé Le cancer bouscule l’arrangement relationnel des patients et de leurs proches. Rappel implacable des exigences de la condition humaine, la maladie grave se pose en assemblage avec une histoire et un contexte singulier. Quand la menace et l’incertain surgissent et se font insistants, l’attente bien légitime d’être accueilli, entendu et rassuré est exacerbée. Cette expérience de vie rappelle l’importance du partage, du soutien et de la solidarité humaine. Les auteurs décrivent une intervention de groupe et les outils proposés aux participants afin de soutenir la personne atteinte de cancer et ses proches lors de cette période de perturbation.
A s clinicians we are often surprised by the difficulty that patients with chronic pain problems have in rehabilitating from relatively minor physical components of a chronic pain syndrome (1-3). We have sometimes noted an apparent inability of chronic pain patients to self-regulate the process of physical rehabilitation, and that detailed instructions of the amount of time to walk, sit up, etc, have been required before rehabilitation can be achieved.A typical example of this is provided by a patient who was initially seen and treated for reflex sympathetic dystrophy of her left foot and who had a recurrence of back pain from surgically treated idiopathic kyphoscoliosis. During on-going psychotherapy for psychological problems underlying her original complaint, we had the chance to observe her regularly over several years. Because of continuing back pain, the bracing rods in her back were removed and an un-united fusion was successfully regrafted. Recovery proceeded well, she was placed in a brace and later returned to work, but she removed the brace for long periods and would only replace it when the pain became intolerable. It seemed that she could not determine the optimum time to replace PAIN RES MANAGE VOL 1 NO 3 AUTUMN 1996Pain Management Centre and Department of Physiotherapy, Royal Victoria Hospital and McGill University, Montreal, Quebec Correspondence: Dr Richard FH Catchlove, Director, Pain Management Centre, Royal Victoria Hospital, 687 Pine Avenue West, Suite S10.51, Montreal, Quebec H3A 1A1. Telephone 514-842-1231 ext 5221, fax 514-843-1723 Received for publication February 12, 1996. Accepted March 26, 1996 AM Hoirch, V Smith, S Beugnot, J Turner, RFH Catchlove. Impaired discriminative function in patients with chronic pain measured by variance in straight leg raising. Pain Res Manage 1996;1(3):146-148.Many chronic pain patients seem to have difficulty regulating exercise programs and require detailed, precise instructions of what exercises to do as well as their frequency and timing. This may be due to a lack of information concerning the state of the damaged tissues, which may result from inadequate feedback mechanisms for pain, stretch and position. The straight leg raising test was used as a model of this mechanism, and variance in targeting the end-point of this test was measured in patients with chronic pain and in controls.Variance about the end-point in chronic pain patients was more than three times larger than that in controls. Although chronic pain patients were older, there was no correlation between straight leg raising and age. The implications of these findings to the maintenance of the original injury and the importance of this in the maintenance and continuation of chronic pain states are discussed.
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