Schmerz最新文献

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.

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: 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.

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.

To enable state-of-the-art diagnosis, therapy and monitoring of headache disorders, comprehensive history taking is necessary and can be time-consuming. This is facilitated substantially if the patient gathers the needed information beforehand, using a specialized questionnaire. To this end, experts of the German Migraine and Headache Society (DMKG) have developed the DMKG headache questionnaire. It assesses central information such as headache frequency, characteristics, accompanying symptoms and medication, as well as comorbidities and validated scales for psychological cofactors, disability and quality of life. The complete version for a first visit is complemented by a shorter version for follow-up visits and a specialized cluster headache module. For headache care professionals, the DMKG headache questionnaire is free after registration ( https://www.dmkg.de/dmkg-kopfschmerzfragebogen ). It is available for a printout or as fillable PDF and can be combined with the included PDF headache diary or with the DMKG-App (smartphone headache diary). A digital version is in the planning. The DMKG headache questionnaire is an important step towards quality assurance of headache care in Germany.

Headache can be a widespread symptom as well as a disorder in itself. Headache syndromes such as migraine cause a lot of distress, disability and overall socioeconomic costs. Pharmacological treatments are often limited in their efficacy as well as due to side effects. The therapeutic application of electricity for this medical indication was a relevant field of research in the 19th century and-in the form of transcranial direct current stimulation (tDCS)-is still widely studied today. This paper provides an overview of publications from the late 19th century (as the era of discovery and success of electrotherapy) as well as contemporary studies investigating the usage of weak currents for the treatment or prophylaxis of headache. Our results show a large number of highly favorable reports of treatment successes. However, the number of cases analysed is often rather small and the forms of electric stimulation applied were often highly heterogeneous. In summary, electric stimulation appears to be a promising field of research and a possible therapeutic agent for the treatment of headaches; however, further research is necessary, especially into the details of the stimulation techniques applied and the various indications in which it may be of use.