Der Schmerz
-
Case Reports Comparative Study
[Deep brain stimulation in the posterior hypothalamus for chronic cluster headache. Case report and review of the literature].
Primary chronic cluster headache (CCH) is a rare but severe pain syndrome and pathophysiological explanations are still missing. PET studies revealed activation in the hypothalamus and therefore it became a target for therapeutic deep brain stimulation (DBS). A case of a 39-year-old woman and a literature review are presented. ⋯ After 7 days the stimulation device was implanted subcutaneously. DBS with implantation of a lead in the ipsilateral inferior posterior hypothalamus is an experimental treatment option and should be offered to selected patients in a prospective controlled clinical trial. Data concerning the long-term follow-up need to be collected.
-
Each individual is entitled to an adequate and sufficient pain therapy. However, only a few studies have examined the peculiarities of pain management in drug-dependent or formerly addicted patients. Any addiction is disadvantageous for a successful pain therapy, since some of the prescribed drugs may themselves cause addiction. ⋯ There are adequate pain therapies for addicted patients. The best results are achieved by taking into account the physiological and psychological peculiarities of drug-dependent patients. Importantly, this should be combined with a variety of different, optimized, multimodal therapeutic regimes, as well as with an interdisciplinary approach.
-
Comparative Study
[Central pain processing in chronic low back pain. Evidence for reduced pain inhibition].
A study of patients with low back pain (LBP) had revealed altered central pain processing. At an equal pain level LBP patients had considerably more neuronal activation in the somatosensory cortices than controls. In a new analysis of this dataset, we further investigated the differences in central pain processing between LBP patients and controls, looking for possible pathogenic mechanisms. ⋯ These findings support a dysfunction of the inhibitory systems controlled by the PAG as a possible pathogenic mechanism in chronic low back pain.
-
Comparative Study
[Role of cognitive pain coping strategies for depression in chronic back pain. Path analysis of patients in primary care].
The concurrent occurrence of chronic pain syndromes and depressive symptoms is a commonly observed phenomenon.The aim of the present study was to illuminate the mediating role of specific cognitive pain coping strategies as a connective link between pain and depression. ⋯ The results give further support for the cognitive mediation hypothesis and enhance it by pointing out the role of specific pain-related cognitive appraisals.
-
Comparative Study
[Acupuncture for chronic pain patients. Treatment outcomes--the role of the acupuncturist].
These results are relevant to the choice of appropriate criteria for quality assessment of acupuncture and emphasize the role of patient satisfaction within quality assurance. Pre- and post-treatment differences in a set of pain related measurements were determined using a combination of data from an observational study and a survey of physicians. The following features of the physicians' study were investigated: specialisation, qualification in acupuncture, rate at which patients received acupuncture, use of further, complementary methods in the practice. ⋯ However, these differences had disappeared 6 months after the onset of acupuncture. These longer term effects were more pronounced for physicians offering additional complementary methods in their practice. Improvement after acupuncture and patient satisfaction were positively correlated.