Der Schmerz
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The therapy of pain caused by rheumatic diseases above all must take into consideration the cause of the pain. In rheumatoid arthritis, especially in the early stages, inflammation is the primary cause of the pain. The pain decreases the inflammation subsides following the administration of non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids, if necessary. ⋯ In most cases fibromyalgia, which is mostly of a psychosomatic nature, cannot be influenced by medical therapy. Instead repeated attempts at treatment help to make the affliction chronic with neurotic fixation. Also, as a rule, myotonolytic and tranquilizing substances are not effective.
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The problem of nociception and pain development in radicular pain syndromes is not clarified. In the pathophysiology of pain of radicular compression caused by stenosis or disc prolapse, morphological complex nerve root/ganglion is the key structure. Chronic compression forces on the nerve structure cause structural changes. ⋯ The membrane threshold shift in nociceptive fibers is an important prerequisite for pain perception in nerve root compression. New biochemical aspects in the pathophysiology of radicular syndromes are presented, which could explain the discrepancy between pain and objective clinical findings. The article concludes that a better understanding of the nerve root pathophysiology will bring a more differentiated pain-management strategy.