Schmerz最新文献

Background: Chronic pain affects millions of people worldwide. Nociplastic pain in particular, characterized by central sensitization and a dysfunctional alarm system, requires innovative therapeutic approaches.

Objective: This review introduces pain reprocessing therapy (PRT) as a promising psychotherapeutic approach to specifically disrupt the pain-fear-pain cycle. The theoretical background, practical implementation, and effectiveness, evidence, and feasibility of this new therapeutic method for treating nociplastic conditions are described and discussed.

Results: PRT enables patients to develop a new understanding of pain and break the pain-fear-pain cycle. Studies and clinical experience demonstrate that this method can achieve a significant reduction in pain intensity.

Discussion: PRT provides an innovative framework for treating chronic pain by combining evidence-based methods and enhancing patient self-efficacy. It has the potential to integrate the biopsychosocial model more effectively into practice and transform the paradigm of pain therapy. Challenges include the diagnostic differentiation of nociplastic pain, the required paradigm shift, and the need for training and time resources. However, studies show promising results for sustainable, patient-centered pain therapy.

Background: Persistent physical symptoms (PPS), including (primary) pain, can, according to Emotional Awareness and Expression Therapy (EAET), be precipitated, perpetuated, and prolonged by emotional processes related to unresolved trauma and psychosocial conflicts. EAET is a novel, short-term, psychodynamic- and emotion-focused psychological treatment that targets these etiological factors, intending to substantially reduce or eliminate pain and/or somatic symptoms.

Objective: This article provides an overview of EAET's theoretical background, core treatment principles, and empirical evidence from randomized controlled trials (RCTs) in alleviating somatic symptoms in people with PPS. Moreover, the potential of EAET and future research directions are discussed.

Methods: We report a selective literature review synthesizing the foundations and treatment characteristics of EAET and the findings from RCTs investigating EAET since 2017.

Results: Grounded in psychodynamic theory, with influences from affective neuroscience and emotion-focused therapy, the core treatment principles are reframing symptom explanations, fostering emotional processing, and facilitating corrective interpersonal experiences. EAET has been implemented in various formats, including individual therapy, group therapy, and internet-administered self-help. Since 2017, seven RCTs have been published, demonstrating efficacy in reducing symptoms, which appears superior to cognitive-behavioral therapy.

Conclusion: EAET is particularly effective for treating chronic (primary) pain conditions such as fibromyalgia and musculoskeletal pain. However, further studies are required to evaluate its long-term efficacy, determine patient characteristics associated with positive outcomes, and better understand its most active mechanisms.

Background: Eye movement desensitization and reprocessing (EMDR) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is also increasingly being used in pain therapy. The use of EMDR can offer a promising therapeutic approach, particularly for patients with previous traumatic experiences.

Objective: This article aims to elucidate the link between chronic pain and traumatic experiences as well as to present the underlying mechanisms, opportunities and limitations of EMDR in this specific context.

Material: Based on a selective literature search, the article summarizes the central concepts of EMDR treatment, such as the dual attention focus and bilateral stimulation, and reviews relevant studies on pain reduction.

Results: Studies show that EMDR not only reduces psychological stress, which contributes to the chronification of pain but can also reduces the intensity of pain itself. Possible mechanisms of action discussed include the stimulation of the working memory and the modulation of neuronal networks.

Conclusion: The integration of EMDR into multimodal pain management programs offers a promising perspective for improving the quality of life in patients with complex pain disorders. Nevertheless, the results emphasize that further research is needed to validate the long-term effectiveness of EMDR and to integrate its use into clinical guidelines; however, the underlying mechanism of action of EMDR is still not conclusively clarified and represents a central goal of future research.

Background: Cognitive behavioral therapy (CBT) is one of the most frequently used and effective procedures in pain psychotherapy. Nevertheless, meta-analyses exhibit significant variability in response to treatment. Graded balance interventions (GBI) are among the CBT measures with a specific indication for pain patients who, according to the avoidance-endurance model (AEM), exhibit dysfunctional pain processing with respect to fear-avoidant or suppressive pain responses.

Aim: The article presents the individual treatment approach of GBI, which is aimed at patients with subacute or chronic pain and an AEM-based dysfunctional pattern of pain processing. Based on the goal of enabling those affected to flexibly alternate between short-term relaxation and resumption of the respective activity with simultaneous pain relief, the concrete procedure is outlined as a model, illustrated by a case study and the preliminary empirical evidence is presented.

Methods: Based on selected empirical literature and clinical case reports, the approach of a modular form of CBT is presented, which, guided by a self-reported screening on pain processing, opens up an individually targeted psychological procedure that can effectively support medical measures.

Results: Based on a large number of randomized, controlled clinical trials on the efficacy of CBT in patients with chronic pain in different locations, a first randomized long-term study with individually targeted GBI shows superiority over a standardized procedure in terms of reduction of pain intensity, impairment and emotional distress in patients with subacute radicular pain.

Conclusion: The use of GBI opens the way to individualization and thus greater homogenization of the approach, based on contrasting patterns of affective, cognitive and behavioral pain processing. The findings to date provide initial indications of the long-term effectiveness of GBI, although there is still a great need for research with respect to its superiority over generalized CBT and into assumed mechanisms of action.

Background: Intensive short-term dynamic psychotherapy (ISTDP) is a psychodynamic treatment model that can achieve medium to strong effects in patients with functional (primary) pain.

Objectives: We aim to summarize the theoretical background, therapeutic techniques, and evidence of ISTDP.

Materials and methods: Narrative literature review.

Results and conclusions: Unlike usual psychodynamic psychotherapy, ISTDP is a highly focused approach. In the treatment of primary pain patients, the aim is to help patients experience their unconscious conflictual feelings that cause various anxiety symptoms (e.g., muscular tension, nausea, gastrointestinal cramps) and are maintained by defense mechanisms. By improving affect tolerance, overcoming maladaptive defense mechanisms, and processing the repressed complex feelings, there is a reduction or even remission from primary pain. ISTDP achieves medium to strong effects in terms of pain reduction and, thus, appears to be superior to cognitive behavioral therapy in the treatment of primary pain. However, further research is needed.

Opioids are essential for analgesia and part of a multifarious group of drugs. The study of the endogenous opioid system and its receptors contributes to a better understanding of the advantages and disadvantages of opioids and to develop possibilities for optimization of new substances. Interactions with the different opioid receptors and the non-opioid effects are important aspects that increasingly need to be considered in the treatment design to ensure safe and effective pain management.

Background: Medication overuse headache (MOH) is often found in patients with chronic migraine as a result of worsening migraine accompanied by increasing amounts of acute medications. MOH is a relevant problem in clinical practice and the current German guideline on MOH recommends educational intervention to guide patients to reduce acute medication use.

Objectives: The aim was to investigate published approaches for education in MO (medication overuse) and MOH.

Methods: A systematic literature search was conducted in PubMed. Publications were included in which details for education for the prevention and treatment in MO or MOH were described. The educational approaches were analyzed thematically.

Results: Twelve publications were included in this analysis. The described educational measures were effective in reducing or preventing MO or MOH. The educational content was heterogeneous, but some common topics were included in most of the educational approaches. These can be categorized in "education on the OH or MOH concept", "risk factors" and "treatment options". In few publications, additional topics related to "agreement on treatment" were mentioned.

Conclusion: Education is effective in patients with medication overuse or medication overuse headache, but approaches differ. The overview presented here can be used as a basis to develop a structured educational approach for MOH.

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.

Complex regional pain syndrome (CRPS) is a severe pain disorder with an unclear pathophysiology. Biomarkers offer opportunities to enhance diagnosis, stratification, prognosis, and monitoring. Serum markers such as cytokines and microRNAs show potential but require further research. Local skin markers, particularly pro-inflammatory cytokines, are elevated in the acute stage and correlate with disease activity. Imaging techniques such as skeletal scintigraphy and functional magnetic resonance imaging provide valuable insights into structural and functional changes, despite inconsistent results to date. Psychosocial factors, including pain intensity and psychological comorbidities, are important prognostic indicators. Future research should focus on specific biomarkers to develop mechanism-based treatments. A multidisciplinary approach remains crucial for effective treatment.