Der Schmerz
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Unrelieved pain is a substantial public health concern owing in part to deficits in clinical expertise among physicians. In most medical faculties worldwide, teaching on pain and pain management is either nonexistent or limited to a small number of students attending voluntary courses. In light of the fact that pain is the most frequent reason to seek medical advice, the lack of formal training of pain medicine is considered the leading reason for inadequate pain management. Therefore, the patients' unmet needs for adequate diagnosis and therapy call for action. ⋯ The introduction of pain medicine into the undergraduate curriculum in Germany is a major challenge regarding the development and implementation processes. This article describes current instruments and implementation strategies for pain medicine as a new cross-sectional subject in Germany.
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In pain therapy neurostimulation procedures have replaced the previously used lesional methods with only very few exceptions. This is especially true for neuropathic pain, i.e. pain which occurs as a direct consequence of a lesion or disease of the somatosensory system. Nowadays, various stimulation procedures are included in the neurosurgical and anesthesiological armamentarium for pain therapy, depending on the site of damage. This article gives an overview of the currently used invasive stimulation procedures and the indications.
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Persistent chronic pain leads to cortical changes in areas involved in the recognition of emotions. Wand et al. suggest a close correlation between the affective pain component and the extent to which these changes occur. As a consequence, the emotion profile may be influenced and difficulties in emotional communication may arise. ⋯ The results suggest changes in the recognition of emotions and that patients with CLBP show signs of alexithymia. Further studies with larger sample sizes are required to confirm the detected trends.