Der Schmerz
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Only some patients with HIV-infection receive an adequate pain therapy. In later stages of HIV-infection up to 50% 6 of patients perform extraordinary doctor visits because of pain. Principally primary and secondary neuromanifestations of HIV-infection have to be differentiated. ⋯ Symptoms of myopathy during HIV-infection are muscle pain, elevation of CK and typical changes of motor units detected by electromyography. In most cases biopsy is necessary for diagnosis of specific forms of HN-associated myopathy. HIV-associated polymyositis is treated by non-steroid analgetics, corticoids, immunoglobulines and plasmapheresis, myopathy induced by neurotoxic medication analogous to polyneuropathy.
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Modern pain therapy began with the discovery of morphine by Sertürner in 1803. The following continuous introduction of new analgesics promised an end of pain as a bane of mankind. Reality, however, soon proved different. ⋯ The first specialised pain clinic opened by Bonica in the USA and the founding of the International Association for the Study of Pain (IASP) have been milestones in the treatment of chronic pain. Today several associations and societies are active promoting both the needs of patients suffering from chronic pain and the needs of the professionals treating pain patients. Although recently physicians can qualify in specialised pain therapy there are still by far too few specialists to provide sufficient care for all chronic pain patients in Germany.
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Specialized pain management centres have been shown to achieve significant clinical efficacy and a relevant reduction of direct and indirect costs. Furthermore, only patients are admitted after conventional therapies failed. The results of specialized pain management might be even more impressive if patients were treated earlier. Parameters of cost efficacy in pain treatment include pain reduction, reduction of drug intake, increase of physical activity, improvement of quality of life, reduction of inability to work, avoidance of early retirement.
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Clinical and experimental studies suggest that a generalized style of hypervigilant information processing may influence the pathogenesis of fibromyalgia (FM). This article deals with the question whether perception and processing of sensory stimuli in patients suffering from FM can be described in terms of "generalized hypervigilance". ⋯ On the whole the existing studies argue against the assumption of trait-like hypervigilant information processing in FM-patients. A more appropriate explanation of the results is in terms of the interaction of situational and personal factors.
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This prospective, non-controlled pilot-study examines the potential benefit of acupuncture in patients with low back pain and radicular symptoms. ⋯ Acupuncture as a noninvasive treatment with very few complications is a promising therapeutical option of low back pain, especially when associated with radicular symptoms.