Der Schmerz
-
Increased pain sensitivity is characteristic for patients with chronic pain disorder with somatic and psychological factors (F45.41). Persistent stress can induce, sustain, and intensify pain sensitivity, thereby modulating pain perception. In this context, it would be favorable to investigate which psychosocial stressors are empirically linked to pain sensitivity. ⋯ Bearing in mind the limitations of this cross-sectional study, these findings may contribute to a better understanding of the link between psychosocial stressors and pain sensitivity.
-
Voltage-gated sodium channels (Navs) are crucial for the generation and propagation of action potentials in all excitable cells, and therefore for the function of sensory neurons as well. Preclinical research over the past 20 years identified three Nav-isoforms in sensory neurons, namely Nav1.7, Nav1.8 and Nav1.9. A specific role for the function of nociceptive neurons was postulated for each. ⋯ Recently, several gain-of-function mutations in Nav1.8 and Nav1.9 have been identified in patients suffering from painful peripheral neuropathies. However, another gain-of-function Nav1.9 mutation is associated with congenital insensitivity to pain. This review offers an overview of published work on painful Nav mutations with clinical relevance, and proposes possible consequences for the therapy of different pain symptoms resulting from these findings.
-
There is preliminary evidence that phantom pain is associated with disturbed organization of the sensory cortex and that this organization can be normalized with two-point discrimination (TPD) training. In this case study, a reduction in phantom pain and painful phantom sensation during a test period of 19 days, was achieved using an automated TPD procedure. In a patient with a transtibial amputation, pain levels decreased from a mean of 2.3/10 on the visual analog scale (VAS) to 1.3/10 (VAS) and the painful phantom sensation level decreased from a mean 3.7/10 (VAS) to 2.0/10 (VAS). These results show a positive trend, but are (except of the nocturnal pain attacks) rather of limited clinical relevance.
-
Standard operating procedures (SOPs) can contribute to the improvement of patient care. ⋯ There is a wide gap between availability and perceived relevance of palliative care SOPs within the network of German CCCs funded by the German Cancer Aid. It is obvious that there is a need for further development of relevant SOPs in palliative care.