Der Schmerz
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Cerebral potentials evoked by cutaneous heat stimuli from an infrared laser (LEP) enable overall controls of thin fibre function and anterolateral tract projection, which is of special meaning in the diagnosis of normal and disturbed pain pathways. Owing to the long-wave radiation, the laser energy is completely absorbed within the most superficial skin layers only a few 100 mum in depth and activates only the most superficial afferents, i.e. the thermo- and nociceptive A, delta and C fibres. According to the particular fibre spectrum activated, a single laser stimulus elicits a typical double pain sensation: the first pain appears with a mean reaction time of approximately 400 ms and is described as a sharp and stinging, well-localizable pinprick sensation; this pain is induced by A delta fibre activity with a mean conduction velocity of 14 m/s. ⋯ Both sensations and both evoked potentials can emerge to very different degrees in healthy subjects and in patients with neurological diseases. The diagnostic practicability of LEP is individuals illustrated with reference to patients with syringomyelia suffering from a dissociated sensory loss in cutaneous sensibility. In contrast to conventional electrical nerve stimuli, the laser stimuli allow monitoring of disturbances in the protopathic system projected to the anterolateral columns.
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This study presents the first-ever account of the prevalence of headache syndromes in Germany and the frequency with which they occur in a large representative sample according to the International Headache Society criteria, as set out in the German translation approved by the Classification Committee. 5000 persons representative of the total population were selected from a panel of 30000 households and requested to answer a questionnaire about headache occurrence during their life to date (lifetime prevalence). Of the 5000 persons who were sent questionnaires, 81.2% (n=4061) completed and returned them: 71.4% (n=2902) said they suffered from headache at least occasionally. Of the base population (all respondents: 100% orn=4061), 27.5% (n=1116) fulfilled the criteria for the IHS classification ofmigraine, 38.3% (n=1557) displayed the criteria oftension headache and 5.6% (n=229) said they suffered from headaches, but did not fulfil the criteria for either migraine or tension headache and were therefore classified in the category other headache. ⋯ The importance of the neurological disorders migraine and tension headache is currently seriously underestimated. They are one of the major health problems of our time. There is an urgent need for much greater attention to them by the health system.
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Anxieties and emotional disturbances associated with cancer often cause pain therapy to be unsuccessful. When psychological support is required it is mostly aimed at supporting cancer patients in attempts to cope with their disease so as to improve the efficiency of pain therapy. In our study we focused on the barriers to cancer pain management that lie in patient's beliefs about pain and their coping behavior. ⋯ Those patients who used cognitive coping strategies and did not communicate often received inadequate pain therapy. Those who talked about pain but did not use any other coping strategies were mostly well treated. We have designed a brochure, "What tumour patients should know about pain" directly oriented on the above pain beliefs; this is now being evaluated with reference to its educational effect.
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In contrast to pain from the skin, muscle pain is often referred to regions remote from the lesion. For instance, trigger points in neck muscles can elicit pain in the head. The convergence-projection theory of Ruch is still the central concept for the explanation of pain referral. ⋯ Therefore, the present paper presents another mechanism, which consists in acute changes in dorsal horn synaptic connections following nociceptive input from muscle. Results from animal experiments indicate that dorsal horn neurons possess ineffective synaptic connections with the body periphery, which become effective under the influence of a painful stimulus and lead to a mislocalization of pain. The neuropeptide substance P is probably involved in the changes in functional organization that occur in the dorsal horn during muscle pain and its referral.
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In the present article aspects of reflex sympathetic dystrophy (RSD) and sympathetically maintained pain (SMP) are discussed from the point of view of a basic scientist. The main focus is on the sympathetic nervous system. ⋯ Finally, clinical observations are discussed that seem to bear little or no relation to the models that are available. The general synopsis puts the problem into a wider context.