Der Schmerz
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Multiple sclerosis and neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, which can lead to a multitude of neurological complaints and pain syndromes. Pain may be an acute symptom during disease exacerbation as well as a chronic symptom, whereby the latter sometimes substantially reduces the quality of life. ⋯ These include central neuropathic pain, pain associated with spasticity, musculoskeletal pain due to excess loading and pain as a side effect of immunotherapy and in the context of comorbidities. The treatment strategies are often insufficiently evidence-based due to the lack of data.
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The concept of chronic overlapping pain conditions (COPC) is relatively unknown in German pain medicine. ⋯ Pain physicians can play a role in the management of patients with endometriosis and COPCs. A multimodal therapy should include physiotherapy and pain-related psychological treatment and possibly centrally acting pain modulation medication.
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Endometriosis is one of the most common diseases in women of reproductive age. Despite characteristic symptoms such as dysmenorrhea, chronic abdominal pain, dysuria, dyschezia and dyspareunia, the average latency until diagnosis is around 10 years. In addition to the individual limitations, the disease also has economic and health policy relevance. The complaints are followed by reductions in working hours, cyclically recurring short-term sick leave or presenteeism with reduced performance. ⋯ Interdisciplinary cooperation is essential in the treatment of patients with (suspected) endometriosis. This team should include all necessary disciplines in a cross-sectoral network. This is most likely to be achieved in a certified structure.
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Review
[Management of endometriosis pain : Stage-based treatment strategies and clinical experience].
Endometriosis is associated with various types of intense pain. In addition to nociceptive pain, there is also a nociplastic reaction with central sensitization. Atypical symptoms such as acyclic lower abdominal pain, radiating pain, non-specific bladder and intestinal complaints or even depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology). ⋯ The use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients.
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Diseases caused by the novel coronavirus (SARS-CoV-2) have led to a pandemic in a very dynamic manner. The epidemiological situation of national importance required infection control measures with the aim of reducing morbidity and mortality. An overburdening of the healthcare system should be avoided. The measures taken to combat the pandemic have had an impact on public and private life. Patients suffering from chronic pain have also been greatly affected. ⋯ It is necessary to maintain the limited but still existing options of coordinated care for pain patients following a multimodal inpatient stay, even in difficult situations. The negative effects of a reduction in medical care are an argument in favor of multimodal outpatient care, especially after inpatient treatment.