ABSTRACT
Nondermatomal somatosensory deficits (NDSDs) are frequently found in chronic pain patients and allude to pain sensitization and pain centralization. In the clinical examination NDSDs are as a rule accompanied by hyposensitivity to touch and heat perception often with a quadrantal or hemibody distribution. The majority of NDSD patients show a trigger episode with a somatic nociceptive trauma in the case history. These somatic findings, however, never fully explain the pain disorder, analogue to the complex regional pain syndrome (CRPS). Most patients with chronic pain disorders as well as those with NDSD often report an antecedent period of high psychobiological stress. The data from functional imaging reveal a complex pattern of a central nervous dysregulation.
Subject(s)
Chronic Pain/physiopathology , Functional Laterality/physiology , Hypesthesia/physiopathology , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/physiopathology , Central Nervous System Diseases/therapy , Cerebral Cortex/physiopathology , Chronic Pain/diagnosis , Chronic Pain/therapy , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/physiopathology , Complex Regional Pain Syndromes/therapy , Diagnosis, Differential , Gyrus Cinguli/physiopathology , Humans , Hypesthesia/diagnosis , Hypesthesia/therapy , Magnetic Resonance Imaging , Neurologic Examination , Pain Measurement/methods , Positron-Emission Tomography , Prefrontal Cortex/physiopathology , Risk Factors , Somatoform Disorders/diagnosis , Somatoform Disorders/physiopathology , Somatoform Disorders/therapy , Somatosensory Cortex/physiopathology , Thalamic Nuclei/physiopathologyABSTRACT
INTRODUCTION: The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. METHODS: One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). RESULTS: The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. CONCLUSION: At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.
