Schmerz最新文献

Background: The importance of dysfunctional coping strategies in the chronification of pain is well documented. The avoidance endurance model (AEM) has proven to be well-suited which, according to initial clinical experiences, is also well-suited to depicting dysfunctional illness behavior in post-COVID syndrome (PCS, COVID coronavirus disease). The aim of this study is to demonstrate which patterns occur and how frequently in PCS patients and whether they change in the context of multimodal rehabilitation.

Method: As part of the PoCoRe multicenter study, N = 481 PCS rehabilitation patients were examined with respect to illness behavior according to the AEM at the start and end of rehabilitation. Frequency analyses, χ²-tests and Sankey diagrams were used.

Results: At the start of rehabilitation around 81.8% of PCS patients exhibited dysfunctional illness behavior, of which 57.7% were dysfunctional endurers (distress endurance response), in 24.1% fear avoidance was present, in 10.0% eustress endurance and in 8.2% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 8.8% towards adaptive response and by 12.7% to eustress endurance, which mainly comes from the former distress endurance types (-6.7%). Fear avoidance decreased by approx. 4.8%. Within the individual AEM reaction patterns, dysfunctional patterns can change in favor of functional patterns as well as functional patterns in favor of dysfunctional patterns.

Conclusion: The clear predominance of dysfunctional patterns in this highly chronified sample suggests that the avoidance endurance concept is also relevant in the chronification of fatigue in PCS. In contrast to chronic pain patients, however, the endurance patterns clearly predominate here. There was a clear shift towards the functional pattern during rehabilitation, which speaks in favor of modifiability; however, around 10-15% of patients developed in an unfavorable direction, which should be taken into account in treatment planning and investigated further.

There is a close bidirectional relationship between chronic pain and psychological trauma disorders, which frequently results in more intense suffering and greater impairment for those affected. This article elucidates the intricate interrelationships between chronic pain, early childhood stress, and traumatic experiences as well as the underlying neurobiological, neuroimmunological and psychosocial mechanisms. Early childhood trauma, such as abuse or neglect, has a significant impact on individuals during particularly vulnerable phases of development, leading to long-lasting changes at various levels. The influence of trauma on pain perception is twofold: it increases the prevalence of chronic pain and intensifies pain and suffering. Therapeutically, interventions that target the hyperactive threat system and strengthen the hypoactive soothing system are essential. The article discusses evidence-based models of pain-trauma interaction and presents therapeutic approaches such as Eye Movement Desensitization Reprocessing (EMDR), Emotional Awareness and Expression Therapy (EAET), and psychodynamic interventions that are promising in the treatment of trauma-associated chronic pain.

Migraine is the most frequent neurological disorder and has a prevalence of 10-14% of the population. In addition to the frequency and the fact that it is usually manifested in adolescence, the frequent comorbid illnesses are also the cause of the high burden associated with migraine. Diseases from very different functional areas are associated with the presence of migraine. In general, this increased risk is more pronounced in the presence of migraine with aura and in women. For example, migraine is associated with a higher risk of developing stroke, heart attack, arterial hypertension, depression, anxiety disorder and probably dementia syndromes. The article presents the most important epidemiological studies on a number of these comorbid diseases. It is unclear what the neurobiological basis is for this accumulation of comorbid diseases in migraine. In addition to the purely coincidental cooccurrence in individual cases, other factors can be responsible for the increased risk: a shared genetic background, e.g. in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) or epileptic seizures, or treatment of a primary independent chronic disease (e.g. treatment with phosphodiesterase inhibitors, hormone substitution therapy or beta-interferon therapy). Another cause, which is discussed more broadly here, is inflammatory mechanisms, which are found in both the triggering of migraine and in a variety of comorbid diseases. This applies primarily to all chronic inflammatory diseases such as rheumatoid arthritis but also to depression and cardiovascular diseases. So far, these findings have not had any influence on the treatment of migraine but this may change in the future with a better understanding of the molecular mechanisms (e.g. activation of microglia).

Background: Antibodies against CGRP or its receptor (eptinezumab, erenumab, fremanezumab, galcanezumab, from here on: "CGRP(R) antibodies") are modern migraine preventives. German statutory health insurance covers CGRP(R) antibodies only for patients refractory to other preventive therapies. Thus, the effect of this regulation on patient selection was investigated, as well as the effect of a change of insurance coverage for erenumab in October 2022.

Methods: In total, 759 patients with CGRP(R) antibody treatment were compared with 961 patients prescribed nonspecific oral migraine preventive medicines (amitriptyline, betablocker, flunarizine, topiramate) from the DMKG Headache Registry.

Results: Patients with CGRP(R) antibodies had more prior preventive therapies that were insufficiently effective or tolerated compared to patients prescribed nonspecific oral preventive medicines (p < 0.001). Moreover, they had longer disease duration (p < 0.001), more often suffered from chronic migraine (p = 0.002), had more severe headache days (p = 0.004) and acute medication days (p = 0.04), lower quality of life (p < 0.05), more comorbidities (p = 0.001), and fewer of them were working (p < 0.001). After change of insurance coverage, treatment with erenumab shifted towards less refractory patients (p < 0.001) with shorter disease duration (p < 0.001), who were less severely affected compared to patients with other CGRP(R) antibodies (e.g., headache days p = 0.01; disability p = 0.005).

Conclusion: CGRP(R) antibodies are prescribed for to patients affected by exceedingly severe migraine. Insurance coverage has a significant effect on use of medicines for migraine prevention.

Background: Persistent pain, one of the most common reasons for suffering and health care seeking, often co-occurs with emotional problems such as depression and anxiety. Within the Center for Health and Medical Psychology at Örebro University, Sweden, we have developed a new treatment aimed at addressing co-occurring persistent pain and emotional problems: hybrid emotion-focused exposure treatment. The overarching idea behind the treatment is that patients who struggle with comorbid pain and emotional problems need to develop skills in dealing with emotions as well as pain. With better skills in tolerating and soothing difficult emotions, patients will be more able to approach previously avoided stimuli and situations, such as movements, activities and social interaction.

Objectives: This review aims to delineate the development of the hybrid emotion-focused exposure treatment. It begins by outlining the theoretical background, then proceeds to describe the techniques, discuss the evidence and conclude with an illustrative case example.

Results: Thus far, the treatment has been tested in a single-case study and a randomized controlled trial with promising outcomes. Overall, the hybrid treatment seems to have a good effect on patients' depressive symptoms and pain interference. The treatment is currently being implemented, and the implementation process evaluated, in primary and specialist care across Sweden.

Conclusions: The hybrid emotion-focused exposure treatment seems to be a well-suited treatment for people with a high burden of persistent pain and emotional difficulties. There is good reason to implement the treatment in clinical practice and continue evaluating treatment effects across different contexts.

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.