Der Schmerz
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Over the last decades, functional imaging studies have fostered our knowledge of cerebral pain processing in humans. A lively interest has been focussing on possible opioidergic mechanisms of pain transmission and modulation. Today, reliable knowledge of the in vivo distribution of opioid receptors in healthy human subjects is available from positron emission tomography (PET) studies of opioidergic neurotransmission. ⋯ Thereby, the ACC apparently executes cortical top-down control on brainstem structures in (exogenous) pharmacological opioid analgesia. In addition, accumulating evidence suggests that non-pharmacological treatment approaches also utilize similar endogenous opioid dependent pathways to exert pain modulation. This article summarizes our current knowledge of PET studies of the opioidergic system and outlines future perspectives.
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Multicenter Study
[Oral transmucosal fentanyl citrate for the treatment of breakthrough pain. Results of a non-interventional study (NIS)].
In a non-interventional study the efficacy and tolerability of oral transmucosal fentanyl citrate (OTFC) was studied in patients with opioid-treated cancer pain suffering from breakthrough pain. ⋯ Oral transmucosal fentanyl citrate is a safe and effective treatment for breakthrough pain in chronic cancer-related pain.
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It is well known that patients with dementia complain less about pain and receive fewer analgesics than other patients. The question arises of whether disorders associated with dementia change the processing of pain. ⋯ Our findings suggest that the processing of acute noxious stimuli is intensified in patients with dementia. Against the background of a reduced prescription of analgesics, an under-treatment of pain in patients with dementia might be the consequence.
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Measurement of the pressure pain threshold and suprathreshold pressure pain sensitivity using a newly developed computer controlled algometer was compared to established methods in this pilot study. ⋯ For clinical use, the algometers investigated deliver comparable results. For studies requiring high precision with low levels of stimulation the use of the Algoforce PA3 could be considered.
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There are few studies on minimally invasive injection therapy (MIT) combined with multimodal conservative therapeutic options. Here, we evaluate the results of MIT in a clinical study. ⋯ MIT is an effective approach with few complications for the treatment of patients with radicular syndromes.