Schmerz最新文献

The development of local anesthetics revolutionized the performance of painful interventions. Local anesthetics have an effect on voltage-gated sodium channels in nerve fibers and modulate the conduction of impulses. With respect to the chemical structure, local anesthetics can be divided into amide and ester types. The structural differences of local anesthetics have an influence on the duration of action, the degradation pathways and specific side effects. Severe adverse events include cardiotoxicity and neurotoxicity. In addition to basic measures, such as the monitoring and securing of vital parameters, lipid infusion represents a treatment option in cases of intoxication. The recent developments of local anesthetics are particularly concerned with the reduction of toxicity and prolonging the duration of action.

The consumption of western diets that are often rich in animal-source foods and low in wholesome, plant-based foods, has grave implications for public health. This is expressed in a growing prevalence of obesity as well as high rates of cardiovascular and metabolic diseases and some cancers. At the same time, current global dietary patterns are major contributors to global environmental challenges, i.e. the climate and the biodiversity crisis, and are thereby a major threat to planetary health. Shifting to more plant-based diets, e.g. in line with the "Planetary Health Diet", provides a major opportunity to improve individual and planetary health. Plant-based dietary patterns with an increase in the consumption of anti-inflammatory and a decrease in pro-inflammatory substances can also lead to improvements in pain symptoms, especially in inflammatory or degenerative joint diseases. In addition, dietary shifts are a prerequisite to achieve global environmental targets and thereby ensure a livable and healthy future for everyone. Medical professionals therefore have a special responsibility to actively promote this transformation.

Introduction: Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations.

Objectives: This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain.

Methods: Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience.

Results: The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication.

Conclusion: This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.

Fibromyalgia syndrome is classified as a functional somatic syndrome. There are typical but not clearly defined symptom clusters, such as chronic widespread pain, non-restorative sleep, and a tendency to physical and/or mental exhaustion. The core principle of treatment in the S3 guidelines is a multimodal treatment, especially for severe forms of the disease. Complementary, naturopathic and integrative forms of treatment have an established place in the guidelines. Strong treatment recommendations with a high consensus exist for endurance, weight and functional training. Meditative forms of movement, such as yoga or qigong should also be used. In addition to a lack of physical activity, obesity is also accepted as an associated lifestyle factor and addressed in nutritional therapy and regulation therapy. The central aim is the activation and rediscovery of self-efficacy. Heat applications, such as warm baths/showers, saunas, infrared cabins or exercise in warm thermal water are in accordance with the guidelines. A current field of research is whole-body hyperthermia with water-filtered infrared A radiation. Other self-help strategies are dry brushing according to Kneipp or massaging with rosemary oil, mallow oil or the Aconite pain oil. Taking into account the patients preference, phytotherapeutic agents can also be used as herbal pain treatment (ash bark/trembling poplar bark/goldenrod herb), for sleep disorders in the form of sleep-inducing wraps (lavender heart compress) and internally (valerian, lavender oil capsules, lemon balm). Acupuncture treatment (either ear or body acupuncture) are accepted as part of a multimodal concept. The Clinic for Integrative Medicine and Naturopathy at the Hospital in Bamberg offers the three different formats of inpatient, day clinic and outpatient service covered by the health insurance.

Background: Complex regional pain syndrome (CRPS) affects 10-15% of patients following injuries (fractures, surgery) to the outer extremities and people after a stroke. The affected area hurts, is inflamed and lacks strength, while mobility and sensitivity are restricted. Complementary medicine as part of integrative medicine offers additional effective treatment options.

Research question: Complementary therapies that extend the guideline recommendations, demonstrate clinical evidence and/or are plausible are presented.

Results: Mind-body medicine procedures (mindfulness, relaxation, yoga, Qi Gong, etc.) support the patient's self-efficacy and stimulate the vagus nerve as well as promoting the reduction of pain, depression and anxiety and improving quality of life. Phytotherapeutics such as turmeric or stinging nettle have an anti-inflammatory effect. Water treatments reduce pain, and acupuncture and neural therapy can be tried.

Conclusions: Integrative, complementary medical therapy options support the CRPS patient in coping with their disease and the related pain. These options can play an important role in the multimodal, interdisciplinary treatment of this disease.

Pain that persists or recurs over a period of at least 3 months in childhood and adolescence is referred to as chronic pain. The primary localization of pain changes according to age: abdominal pain is more common at a younger age, headache is more common in adolescents and later back pain as well as muscle and joint pain. In the multimodal and interdisciplinary treatment of chronic pain, complementary procedures can expand the treatment spectrum. This article provides an overview of the existing evidence that for childhood and adolescence can at best be evaluated as readily understandable. In addition, the experiences of two children's hospitals show that complementary medicine can be used as a low-threshold and easily implemented therapy.

Background: With a prevalence of up to 30%, shoulder disorders form the third largest group of musculoskeletal complaints worldwide. Their formation and development are influenced by psychosocial factors such as movement-related fear. One of the internationally most common measurements for quantifying fear of movement is the Fear-Avoidance Beliefs Questionnaire (FABQ).

Objectives: To investigate the reliability (internal consistency) and validity (structural validity, construct validity, predictive validity) of the FABQ‑D in a shoulder pain population.

Materials and methods: Subjects with shoulder pain were included in a multicenter cross-sectional study. In addition to fear-avoidance beliefs, pain intensity, subjective impairment in daily life and kinesiophobia were recorded. To this end, the FABQ‑D, numeric rating scale (NRS), Shoulder and Pain Disability Index (SPADI) and the Tampa Scale for Kinesiophobia (TSK-GV) were used.

Results: A total of 49 subjects (24 women and 25 men) with a mean age of 41.8 years (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency of the FABQ‑D (Cronbach's α = 0.88). The homogeneity factor differs significantly between the subscales (Loevinger's H = 0.66-0.9). The correlation analyses did not show any clear convergence of the FABQ‑D with the TSK-GV (r = 0.3501; p = 0.0137). A divergence to the constructs of the NRS (r = 0.1818; p = 0.2112) and SPADI (r = 0.4415; p = 0.0015) were confirmed. The hypothesis testing resulted in 42.87% of the assumed hypotheses and therefore a low construct validity. The FABQ‑D and the TSK-GV showed a significant influence on the duration of the complaints (R² = 0.3652; p ≤ 0.0001). It was also shown that the greatest factors for a high FABQ‑D value were functional impairment (SPADI) and duration of symptoms (R² = 0.3066; p = 0.0002). The subgroup analysis showed a significantly higher FABQ‑D value in older subjects (40-65 years; t = 3.8084/df = 47, p = 0.0002).

Conclusion: The FABQ‑D is a reliable measurement tool. The construct validity should be further investigated in future studies. This study reproduced results from previous studies in other populations. The FABQ‑D appears to be an adequate measurement tool for quantifying fear of movement in patients with shoulder disorders.