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[Cannabis: does the new law bring new possibilities?] [大麻:新法律是否带来了新的可能性?]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-19 DOI: 10.1007/s00482-024-00817-x
Peter Cremer-Schaeffer
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引用次数: 0
[Updated S1 guideline on long/post-COVID: relevant aspects for pain medicine]. [关于长期/COVID 后的 S1 指南更新版:疼痛医学的相关方面]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2023-03-16 DOI: 10.1007/s00482-023-00704-x
Christina Lemhöfer, Andreas Rembert Koczulla, Winfried Meissner, Winfried Häuser

Background: The S1 guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August 2022.

Methods: Under the coordination of the German Society of Pneumology, the guideline was updated by 21 scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed a selective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions.

Results: Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. A specialist assessment might be considered if symptoms with limitations of daily activities persist 3 months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF.

Conclusions: The updated S1 guideline on long/post-COVID is a clinical manual which offers orientation for diagnostics and treatment despite limited data.

背景:2022 年 8 月,德国医学科学协会(AWMF)(注册号:020-027)更新了关于长期/COVID 后的 S1 指南:在德国肺病学会的协调下,21 个科学协会、两个专业协会和临床中心以及一个研究所和法定意外保险机构对该指南进行了更新。每个科学协会负责各自的章节。德国疼痛学会编写了 "疼痛 "一章。每个章节的协调人都进行了有选择性的文献检索,并在其科学协会内部获得了对该章节的批准。在内部征求意见期间,所有参与机构的代表都可以对所有章节发表意见。AWMF 特别工作组对指南草案进行了评论,最后由所有参与机构的董事会批准:结果:2019 年冠状病毒病(COVID-19)会增加持续性头痛和肌肉骨骼疼痛的风险。长期/COVID后疼痛经常与疲劳和认知问题相关联。如果感染 3 个月后仍有症状,且日常活动受限,则应考虑进行专科评估。长/后COVID相关疼痛的诊断工作应根据疼痛医学标准进行。治疗应遵循 AWMF 的疼痛指南:尽管数据有限,但更新后的 S1 长程/后程 COVID 指南是一本临床手册,为诊断和治疗提供了方向。
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引用次数: 0
[Collateral effects of the pandemic]. [大流行病的附带影响]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-23 DOI: 10.1007/s00482-024-00812-2
Lukas Radbruch
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引用次数: 0
[Retrospective evaluation of electronically recorded patient questionnaires of a university outpatient pain clinic with the painDETECT® questionnaire]. [用painDETECT®问卷对一家大学疼痛门诊的电子记录患者问卷进行回顾性评估]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2022-11-24 DOI: 10.1007/s00482-022-00677-3
N Foadi, I Winkelmann, M Rhein, M Karst

Background and objective: Psychometric tests can provide important information for diagnostics and progression in chronic pain patients. Between 2008 and 2018, the electronic system painDETECT® was used in the outpatient pain clinic of the Hannover Medical School (MHH). The aim of this retrospective study was to evaluate the pain symptomatology data recorded using painDETECT® and the treatment procedures used in the patient cohort examined over a period of 15 months.

Material and methods: A statistical analysis of baseline and follow-up data was performed. The analysis comprised pain-related parameters recorded by use of the painDETECT® system as well as outpatient records.

Results: Baseline data of 459 patients (66% women) could be evaluated. The most common clinical pictures were spinal pain, headache, facial pain, and somatoform disorders, mostly with many years of previous treatment. Approximately 40% showed evidence of neuropathic pain components or central sensitization. With a mean pain intensity of VAS 6 (0-10), a predominantly high degree of chronicity was present. Approximately one third showed a high degree of pain-related functional impairment. Slightly more than half showed evidence of clinically relevant depression. Approximately 80% showed clinically relevant sleep disturbances. Follow-up data were available for 145 patients (31.6%). The proportion of patients receiving a nonpharmacological form of treatment increased by 44.1% (physical therapy) and by 24.1% (psychotherapeutic procedures) during the observation period. The use of co-analgesics increased by approximately 30% over the course.

Conclusion: In the outpatient setting, an extension of treatment can be successful for high-grade chronic pain patients. Close structural networking with the clinics for rehabilitation medicine and for psychosomatics and psychotherapy at the MHH can be a favorable prerequisite for this.

背景和目的:心理测试可为慢性疼痛患者的诊断和病情发展提供重要信息。2008 年至 2018 年期间,汉诺威医学院(MHH)疼痛门诊使用了电子系统 painDETECT®。这项回顾性研究的目的是评估使用painDETECT®记录的疼痛症状数据,以及在15个月内对患者队列进行检查时使用的治疗程序:对基线数据和随访数据进行了统计分析。分析包括使用painDETECT®系统记录的疼痛相关参数以及门诊记录:结果:共评估了 459 名患者(66% 为女性)的基线数据。最常见的临床症状是脊柱疼痛、头痛、面部疼痛和躯体形式障碍,其中大多数患者都曾接受过多年的治疗。约 40% 的患者有神经病理性疼痛或中枢敏化的迹象。平均疼痛强度为 VAS 6(0-10),主要表现为高度慢性化。约三分之一的患者表现出高度的疼痛相关功能障碍。略多于一半的患者表现出临床相关的抑郁。约 80% 的患者出现临床相关的睡眠障碍。有 145 名患者(31.6%)获得了随访数据。在观察期内,接受非药物治疗的患者比例增加了 44.1%(物理治疗)和 24.1%(心理治疗)。在观察期间,联合镇痛剂的使用增加了约30%:结论:在门诊环境中,延长慢性疼痛患者的治疗时间可以取得成功。与MHH的康复医学、心身医学和心理治疗诊所建立密切的结构性联系是实现这一目标的有利前提。
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引用次数: 0
[Kinesiophobia in shoulder disorders : Validation of the German version of the Tampa scale for kinesiophobia (TSK-GV)]. [肩部疾病中的运动恐惧症:坦帕运动恐惧症量表(TSK-GV)德文版的验证]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2022-12-02 DOI: 10.1007/s00482-022-00678-2
Larissa Pagels, Kerstin Lüdtke, Axel Schäfer

Background: With a prevalence of 7-30%, shoulder disorders form the third largest group of musculoskeletal complaints. Their formation and development is influenced by, e.g. psychological factors. The Tampa scale for kinesiophobia (TSK) is the most common measure for quantifying fear of movement.

Objectives: To investigate the reliability and validity of the German version of the TSK (TSK-GV) in a shoulder pain population.

Materials and methods: Subjects with shoulder pain were included in a multicenter cross-sectional study. In addition to kinesiophobia, pain intensity, subjective impairment in daily life and fear-avoidance beliefs were recorded.

Results: A total of 49 subjects (24 women and 25 men) with a mean age of 41.8 (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency (Cronbach's α = 0.81). The homogeneity of the scale is poor (Loevinger's H = 0.35). The correlations did not show any clear convergence of the TSK-GV with the fear-avoidance beliefs questionnaire (FABQ) (r = 0.3501; p = 0.0137). The divergent validity was confirmed for both the numerical rating scale (NRS) (r = 0.1216; p = 0.4052) and the shoulder pain and disability index (SPADI) (r = 0.2571; p = 0.0745). The hypothesis testing resulted in 28.57% accepted hypotheses. There was a significant influence of the TSK-GV and the FABQ on the duration of complaints (R2 = 0.3652; p ≤ 0.0001), as well as an explained variance of the duration of complaints on the TSK-GV of R2 = 0.1834 (p = 0.0021). The subgroup analysis showed a significantly higher degree of kinesiophobia in male subjects (t = 3.8084/df = 47; p = 0.0002).

Conclusion: The TSK-GV is a reliable measurement tool. The construct validity should be further investigated in future studies. This study shows comparable values to previous studies in other populations. The TSK-GV is to date the only validated German language measure for recording fear of movement in shoulder disorders and shows an acceptable fit for this population.

背景:肩关节疾病的发病率为 7-30%,是肌肉骨骼疾病中的第三大类。其形成和发展受到心理因素等的影响。坦帕运动恐惧量表(TSK)是量化运动恐惧的最常用方法:目的:研究德国版 TSK(TSK-GV)在肩痛人群中的可靠性和有效性:一项多中心横断面研究纳入了肩痛受试者。除运动恐惧外,还记录了疼痛强度、日常生活中的主观障碍和恐惧逃避信念:共纳入 49 名受试者(24 名女性和 25 名男性),平均年龄为 41.8 岁(SD = 12.8)。量表项目的描述性评估结果显示其内部一致性良好(Cronbach's α = 0.81)。量表的同质性较差(Loevinger's H = 0.35)。相关性研究表明,TSK-GV 与恐惧逃避信念问卷 (FABQ) 没有明显的趋同性 (r = 0.3501; p = 0.0137)。数字评分量表(NRS)(r = 0.1216; p = 0.4052)和肩痛与残疾指数(SPADI)(r = 0.2571; p = 0.0745)的发散有效性得到了证实。假设检验的结果是28.57%的假设被接受。TSK-GV 和 FABQ 对主诉持续时间有明显影响(R2 = 0.3652;p ≤ 0.0001),TSK-GV 对主诉持续时间的解释方差为 R2 = 0.1834(p = 0.0021)。亚组分析显示,男性受试者的运动恐惧程度明显更高(t = 3.8084/df = 47; p = 0.0002):结论:TSK-GV 是一种可靠的测量工具。结论:TSK-GV 是一种可靠的测量工具,在今后的研究中应进一步探讨其构造效度。本研究显示的数值与之前在其他人群中进行的研究具有可比性。TSK-GV是迄今为止唯一经过验证的记录肩关节疾病患者运动恐惧的德语测量工具,其与该人群的契合度可以接受。
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引用次数: 0
[On the difficulty of dealing with words and concepts]. [关于处理词语和概念的困难]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-21 DOI: 10.1007/s00482-024-00801-5
Lukas Radbruch
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引用次数: 0
[On the difficulty of dealing with words and terms and what may possibly help]. [关于处理文字和术语的困难以及可能的帮助]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-20 DOI: 10.1007/s00482-024-00800-6
Harald Lucius
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引用次数: 0
[Interdisciplinary multimodal pain therapy in postviral syndromes and ME/CFS : Features, pitfalls and model concept]. [病毒后综合征和脑脊髓炎/慢性疲劳综合征的跨学科多模式疼痛治疗:特征、陷阱和模型概念]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2023-10-20 DOI: 10.1007/s00482-023-00761-2
Benjamin Luchting, Uta Behrends, Bianca Eigner, Silvia Stojanov, Cordula Warlitz, Matthias Haegele, Eva Neuwirth, Lorenz Mihatsch, Hans Peter Richter

Background: Multimodal pain therapy usually take place in the context of group therapy lasting several weeks and is based on a generally activating approach. Due to the specificity of stress intolerance with postexertional malaise (PEM) in patients with postviral syndromes, physical as well as psychological overload must be urgently avoided in these cases; however, these aspects can only be insufficiently considered in current medical pain therapy concepts.

Methods: Summary of the current literature and presentation of clinical characteristics as well as presentation of a model project for a multimodal pain therapy in postviral syndromes with PEM.

Model concept: The presented model project describes a day clinic treatment setting for interdisciplinary multimodal pain therapy adapted to the individual resilience with minimization of the risk of strain-induced deterioration of the condition.

背景:多模式疼痛治疗通常在持续数周的集体治疗中进行,并基于一种普遍的激活方法。由于病毒后综合征患者的应激不耐受和运动后不适(PEM)的特异性,在这些情况下,必须紧急避免身体和心理超负荷;然而,在目前的医学疼痛治疗概念中,这些方面只能得到充分的考虑。方法:总结现有文献,介绍临床特征,并介绍PEM病毒后综合征多模式疼痛治疗的模型项目。模型概念:所介绍的模型项目描述了跨学科多模式疼痛疗法的日间临床治疗环境,该治疗环境适应个体复原力,并将应变引起的条件恶化。
{"title":"[Interdisciplinary multimodal pain therapy in postviral syndromes and ME/CFS : Features, pitfalls and model concept].","authors":"Benjamin Luchting, Uta Behrends, Bianca Eigner, Silvia Stojanov, Cordula Warlitz, Matthias Haegele, Eva Neuwirth, Lorenz Mihatsch, Hans Peter Richter","doi":"10.1007/s00482-023-00761-2","DOIUrl":"10.1007/s00482-023-00761-2","url":null,"abstract":"<p><strong>Background: </strong>Multimodal pain therapy usually take place in the context of group therapy lasting several weeks and is based on a generally activating approach. Due to the specificity of stress intolerance with postexertional malaise (PEM) in patients with postviral syndromes, physical as well as psychological overload must be urgently avoided in these cases; however, these aspects can only be insufficiently considered in current medical pain therapy concepts.</p><p><strong>Methods: </strong>Summary of the current literature and presentation of clinical characteristics as well as presentation of a model project for a multimodal pain therapy in postviral syndromes with PEM.</p><p><strong>Model concept: </strong>The presented model project describes a day clinic treatment setting for interdisciplinary multimodal pain therapy adapted to the individual resilience with minimization of the risk of strain-induced deterioration of the condition.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49681855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Treatment expectations of multimodal pain therapy inpatients]. [住院病人对多模式疼痛疗法的治疗期望]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2022-12-02 DOI: 10.1007/s00482-022-00681-7
Katrin Zimmermann, Stephanie Dannemann, Katja Prate, Anne Keller, Nathalie Blaue, Kerstin Weidner, Uwe Ettrich

Background: Apart from rehabilitation research, there have been no studies regarding the expectations of patients with chronic back pain in terms of inpatient multimodal pain therapy. The aim of this naturalistic longitudinal study is to explore treatment expectations, their fulfilment, and influence on the treatment success of inpatient multimodal pain therapy.

Methods: This study included 118 patients with chronic back pain who were physically examined and assessed for their psychological comorbidity. They were interviewed pre and post pain therapy. Treatment expectations were recorded via the questionnaire for assessing rehabilitational expectations and motivations (FREM-17), and further variables via the Pain Disability Index (PDI, german version) and the german Hospital Anxiety and Depression Scale (HADS-D).

Results: The results show that treatment expectations have an impact on therapy success or failure. In particular, patients' expectations of coping with illness and recovery could be met by inpatient multimodal pain therapy, whereas health and pension-related expectations remained unfulfilled. In addition to the treatment expectations, the therapy result was primarily determined by the patient's ability to perform before the therapy.

Conclusions: From the clinical side, treatment expectations should be explored and checked for feasibility to avoid patient disappointment.

背景:除康复研究外,还没有关于慢性背痛患者对住院多模式疼痛疗法期望的研究。本自然纵向研究旨在探讨住院患者对多模式疼痛疗法的治疗期望、期望的实现情况以及对治疗成功的影响:这项研究包括 118 名慢性背痛患者,他们接受了身体检查和心理合并症评估。在疼痛治疗前后对他们进行了访谈。治疗期望通过康复期望和动机评估问卷(FREM-17)进行记录,其他变量通过疼痛残疾指数(PDI,德国版)和德国医院焦虑抑郁量表(HADS-D)进行记录:结果显示,治疗期望对治疗的成败有影响。结果表明,治疗期望对治疗的成败有影响。尤其是,住院多模式疼痛疗法可以满足患者对应对疾病和康复的期望,而与健康和养老金相关的期望则仍然无法实现。除了治疗期望外,治疗结果主要取决于患者在治疗前的能力:结论:从临床角度来看,应探讨治疗期望并检查其可行性,以避免患者失望。
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引用次数: 0
[Sequence variants of unknown significance in small fiber neuropathy : Characterization of a heterogeneous patient population]. [小纤维神经病中意义不明的序列变异:异质性患者群体的特征]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-05-07 DOI: 10.1007/s00482-024-00811-3
Caren Meyer Zu Altenschildesche, Nadine Egenolf, Annette Lischka, Nurcan Üçeyler

Background: In almost half of patients suffering from small fiber neuropathies (SFN), the etiology remains elusive. For these patients with "idiopathic SFN", symptomatic analgesic therapy is the only option. Reports on a potential genetic background of neuropathic pain syndromes are increasing and particularly in SFN patients, several genetic variants were found mainly located in genes encoding voltage-gated sodium channels. Although up to 30% of SFN patients show genetic alterations, most of these remain of "unknown pathogenic significance" and little is known about "genetic SFN".

Objectives: The study aimed to determine clinical characteristics of SFN patients carrying a rare genetic variant of unknown significance in pain-associated genes.

Materials and methods: From 2015 to 2020, 66 patients with primarily idiopathic SFN were examined and rare gene variants of unknown significance detected in 13/66 (20%) of these. A detailed medical history with focus on pain was recorded and patients filled in standardized questionnaires to assess physical and emotional burden due to pain.

Results: The authors found 13/66 (20%) patients with rare variants of unknown significance located in pain-associated genes who reported pain refractory to analgesic treatment, a higher number of external factors influencing clinical symptoms, and a higher level of physical impairment and emotional stress due to pain compared with patients without such genetic variants.

Conclusions: Early genetic assessment is recommended to optimize the management of patients with potentially hereditary SFN. Early access to rehabilitation and mental support as well as a consequent elimination of external triggering factors should be granted.

背景:近一半的小纤维神经病(SFN)患者病因仍然不明。对于这些 "特发性 SFN "患者,对症镇痛疗法是唯一的选择。有关神经病理性疼痛综合征潜在遗传背景的报道越来越多,特别是在 SFN 患者中发现了几种主要位于编码电压门控钠通道基因的遗传变异。虽然多达 30% 的 SFN 患者会出现基因变异,但其中大多数仍 "致病意义不明",人们对 "遗传性 SFN "知之甚少:该研究旨在确定携带疼痛相关基因中意义不明的罕见遗传变异的 SFN 患者的临床特征:从 2015 年到 2020 年,共对 66 名主要为特发性 SFN 的患者进行了检查,并在其中 13/66 例(20%)患者中检测到了意义不明的罕见基因变异。研究人员记录了以疼痛为重点的详细病史,患者还填写了标准化问卷,以评估因疼痛造成的身体和精神负担:作者发现,13/66(20%)的患者在疼痛相关基因中存在意义不明的罕见变异,与不存在此类基因变异的患者相比,他们报告的疼痛对镇痛治疗难治,影响临床症状的外部因素较多,因疼痛导致的身体损伤和情绪压力水平较高:建议尽早进行遗传评估,以优化对潜在遗传性 SFN 患者的管理。结论:建议及早进行遗传评估,优化对潜在遗传性 SFN 患者的管理,及早给予康复治疗和精神支持,从而消除外部诱发因素。
{"title":"[Sequence variants of unknown significance in small fiber neuropathy : Characterization of a heterogeneous patient population].","authors":"Caren Meyer Zu Altenschildesche, Nadine Egenolf, Annette Lischka, Nurcan Üçeyler","doi":"10.1007/s00482-024-00811-3","DOIUrl":"https://doi.org/10.1007/s00482-024-00811-3","url":null,"abstract":"<p><strong>Background: </strong>In almost half of patients suffering from small fiber neuropathies (SFN), the etiology remains elusive. For these patients with \"idiopathic SFN\", symptomatic analgesic therapy is the only option. Reports on a potential genetic background of neuropathic pain syndromes are increasing and particularly in SFN patients, several genetic variants were found mainly located in genes encoding voltage-gated sodium channels. Although up to 30% of SFN patients show genetic alterations, most of these remain of \"unknown pathogenic significance\" and little is known about \"genetic SFN\".</p><p><strong>Objectives: </strong>The study aimed to determine clinical characteristics of SFN patients carrying a rare genetic variant of unknown significance in pain-associated genes.</p><p><strong>Materials and methods: </strong>From 2015 to 2020, 66 patients with primarily idiopathic SFN were examined and rare gene variants of unknown significance detected in 13/66 (20%) of these. A detailed medical history with focus on pain was recorded and patients filled in standardized questionnaires to assess physical and emotional burden due to pain.</p><p><strong>Results: </strong>The authors found 13/66 (20%) patients with rare variants of unknown significance located in pain-associated genes who reported pain refractory to analgesic treatment, a higher number of external factors influencing clinical symptoms, and a higher level of physical impairment and emotional stress due to pain compared with patients without such genetic variants.</p><p><strong>Conclusions: </strong>Early genetic assessment is recommended to optimize the management of patients with potentially hereditary SFN. Early access to rehabilitation and mental support as well as a consequent elimination of external triggering factors should be granted.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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