Schmerz最新文献

Background: Pain is the leading cause of disease burden and disability worldwide. Physiotherapy plays a major role in the treatment of people with pain; however, there appears to be a lack of knowledge in this area.

Aim: The aim of the nationwide study was to quantify the pain knowledge and postural, structural and biomechanical (PSB) orientation of physiotherapy lecturers (PL) in Germany.

Methods: An online test, which included the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ), in which the achieved score is given from 0-100%, was answered by N = 184 PLs (n = 165 physiotherapists, n = 19 physicians) using SoSci Survey. A satisfactory result is achieved when at least 90% of participants achieve a score of at least 66.67%.

Results: The mean score of the rNPQ‑D was 73.91% ± 13.11% and of the EKPQ 42.03% ± 20.78%, with statistically significant lower scores in the EKPQ (p < 0.001; d = 1.594). In both tests less than 90% of participants achieved a score of at least 66.67% (rNPQ-D: 79.89% of participants; EKPQ: 13.59% of participants). Teaching physicians achieved significantly lower scores in the EKPQ than teaching physiotherapists (p < 0.05; d = 0.494). The PLs who achieved their highest educational qualification abroad achieved higher scores than PLs with their highest educational qualification in Germany (rNPQ-D: p < 0.05 and d = 0.666; EKPQ: p < 0.05 and d = 0.649). Academized PLs achieved higher scores on average than nonacademized PLs, which was significant for the rNPQ‑D (p < 0.05, d = 0.38). Neither the professional and teaching experience of the PLs nor the number of their further training courses were related to the level of the respective test scores. The PLs with specific further training, such as manual lymphatic drainage, fascia therapy or physiotherapy according to Bobath, achieved significantly lower scores.

Conclusion: The knowledge of German PLs about pain is deficient and strongly PSB-oriented, despite the responsible task of correctly imparting knowledge to future physiotherapists. In addition to the education and further training of physiotherapists, a comprehensive implementation of modern pain neuroscience knowledge in the curricula should be strived for.

Background: Patients with chronic widespread pain (CWP) and/or fibromyalgia syndrome (FMS) are considered difficult to treat. Various disease models and treatment preferences exist.

Objective: To assess subjective perspectives on etiological factors, disease models and treatment preferences of patients, general practitioners (GP) and psychotherapists regarding FMS/CWP.

Methods: From December 2019 to February 2020 questionnaires were sent to 88 patients with FMS/CWP from a neurological psychiatric practice in the Allgäu region of Germany and also to 146 GPs and 88 psychotherapists from the district. A total of 30 patients (34 %), 19 GPs (13 %) and 10 psychotherapists (11 %) participated.

Results: Neglect, traumatization and impaired emotional awareness and/or emotional expression were predominantly named as etiologically significant. Patients, GPs and psychotherapists mainly assume a psychosomatic/psychological cause, but 67 % of patients also (tended to) assume a physical cause. For all groups, lifestyle changes and psychotherapy were therapeutically important. Patients emphasized somatic treatment approaches, while GPs in particular were in favor of psychopharmacological treatment. Those patients who assumed a psychological/psychosomatic disease model tended to consider psychopharmacological treatment and psychotherapy to be important.

Conclusion: Although the low response rates limit the significance of the results, patients, GPs and psychotherapists, who are related to a neurological/psychiatric practice, confirmed aversive childhood experiences and impaired emotional awareness/emotional expression as etiologically important, mainly assumed a psychological/psychosomatic etiology and predominantly favored treatment in the form of lifestyle changes and psychotherapy.

Theoretical background: Negatively experienced emotions, especially anger, influence pain-related variables and impair the quality of life. Although a variety of treatment approaches exist there is still no comprehensive overview of anger-related interventions for chronic pain and which effects with respect to anger-specific and pain-specific variables can be detected.

Methods: To answer these questions, a systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review included a comprehensive literature search that identified and analyzed relevant studies on anger-related interventions for primary chronic pain. These studies were compared with respect to the interventions used, the variables studied and the results obtained.

Results: In the extracted studies (n = 5) significant positive effects of specific anger-related interventions on both pain-related and anger-related variables could be demonstrated.

Discussion: Anger-focused treatment approaches are consequently considered a promising therapeutic option for chronic pain. To optimize their application in clinical practice further research on the effects and mechanisms of anger-related interventions is recommended.

A high percentage of the world's population suffers from diabetes mellitus (DM). The disease leads to considerable DM-related pathological consequences and aggravates disease processes and pain as a comorbidity. This has a significant impact on the quality of life of these patients. This article describes DM-induced mechanisms that may contribute to increased pain. Diabetic patients exhibit low-grade systemic inflammation, high levels of blood glucose, and increased formation and accumulation of advanced glycation end products (AGEs). These factors can activate intracellular inflammatory signaling pathways and induce reactive oxygen species (ROS) formation, which can lead to the release of cytokines, oxidative stress, and mitochondrial dysfunction. These processes lead to increased local inflammation and damage to blood vessels and nerve fibers, which are considered to be causes of many diabetic complications. The increased release of pro-inflammatory mediators contributes to peripheral and central sensitization and thus to increased acute and chronic pain in diabetic patients. About 50% of people with DM develop diabetic neuropathy, which can cause numbness, discomfort, or severe pain. In addition, diabetic patients have an increased incidence of musculoskeletal disorders, which can cause additional pain.

Fatigue and chronic pain show a high level of comorbidity and are both not only frequent symptoms of chronic diseases without known somatic structural causes (e.g. irritable bowel syndrome or nonspecific low back pain) but also as leading symptoms of diseases with a specific etiology (e.g., cancer, rheumatoid arthritis or multiple sclerosis). Fatigue and pain also often co-occur for months or years after overcoming an acute organic illness, such as an acute bacterial or viral infection. In all cases, fatigue and pain can be accompanied by increased anxiety or depression. Moreover, research indicates that psychosocial factors, such as emotional distress, dysfunctional behavioral responses to fatigue or pain or social stigmatizing, can be involved in the perpetuation of the complaints and also independent of the etiology of the underlying disease. Physiological processes, such as autonomic dysregulation, an altered activation of adrenocortical activity as well as altered brain activity are increasingly being discussed as biological mechanisms. These common factors suggest a transdiagnostic approach investigating overlapping features in terms of biopsychosocial mechanisms that may play a role not only in the maintenance of pain but also of fatigue. As a consequence, both the diagnostics and management can be provided in a more individualized and resource-efficient way. The present narrative review gives a preliminary summary of the transdiagnostic mechanisms and possible clinical approaches for fatigue and chronic pain.

A person's rights to freedom and self-determination are a valuable asset. At the same time, the state has an obligation to protect life. Tension can arise between these equally important, immutable guarantees in Articles 1 and 2 of the German Basic Law if a person is suffering from severe pain due to an illness and there is no prospect of a cure. If a patient in this situation expresses the wish to die, this represents a major challenge for those providing treatment. Personal conflicts of conscience and uncertainty about the legal situation mean that the patient does not receive the treatment desired for the last phase of life. This article discusses the difficult topic of "assisted dying", primarily from a legal perspective. Which (medical) actions are punishable, which are not? What is the legislator doing to ensure legal certainty for everyone involved? How can patients make their own arrangements to ensure that their right to autonomy is respected at the end of life?

Background: The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain.

Aim of the study: Data on the prevalence of short- and long-term opioid prescriptions for patients without cancer, prescribed agents, co-medication, specialty of prescribing physicians, demographic and clinical characteristics of patients.

Materials and methods: Retrospective analysis of billing data of adult BARMER-insured persons without evidence of cancer (N = 6,771,075) in 2021 and for patients initiating opioid therapy in 2019 (n = 142,598).

Results: In total, 5.7% of the insured persons without a cancer diagnosis received at least one prescription for an opioid in 2021, while 1.9% received long-term therapy. Tilidine and tramadol were the most frequently prescribed opioids in short- and long-term therapy. Women received opioids more frequently than men. The frequency of prescriptions significantly increased with age. In 2021, 22.5% of insured persons with long-term opioid therapy received a co-medication with pregabalin and/or gabapentin, 37.5% with an antidepressant and 58.1% with metamizole and/or NSAIDs. A total of 59.5% of first prescriptions were issued by general practitioners. In the first year of therapy, an average of 2.1 practices were involved in prescribing analgetics for people on long-term opioid therapy and 13 different chronic diseases were documented.

Discussion: Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as a review of possible drug interactions.