Der Schmerz
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Prolonged administration of morphine for the treatment of chronic pain causes constipation requiring the use of laxatives, which may result in electrolyte deficits. Morphine-induced constipation is due to the binding of the drug to opioid receptors in the gastrointestinal tract and the brain, where it mimics the actions of enkephalins. The effect on the gastrointestinal tract seems to be more intense than the central effect. ⋯ Provided that the anatomical organization of the haemorrhoidal veins in the rat is similar to that in man, slow-release naloxone will be carried by the matrix, to which it is absorbed further down in the gastrointestinal tract. It may thus even reach the rectum, from where, after having been absorbed, it bypasses the liver, enters the central nervous system and reduces the antinociceptive effect of morphine. In conclusion, it can be stated that oral administration of naloxone in combination with morphine may help to prevent constipation during the treatment of chronic pain.
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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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Several studies of contingent negative variation (CNV) examined whether this method provides a suitable basis for research on pathogenetic processes in chronic headaches-especially migraine. In the present study, the CNV amplitudes and CNV course of 23 migraine patients were compared with those of 22 healthy subjects. CNV was calculated for (a) "total interval", (b) "early CNV component", and (c) "late CNV component". ⋯ The results allow the assumption that the higher level of CNV amplitude in migraine patients is not only due to higher cortical noradrenergic or serotoninergic activation. This study shows that migraine patients cannot decrease their CNV amplutides. This is probably due to defective processing of sensory imput.
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This paper reviews several recently developed animal models that allow a quantitative assessment of the magnitude of nocifensive behavioral responses across a range of noxious stimulus intensities. Models discussed in detail include: (a) the rodent tail flick reflex, and a modification that allows measurement of tail flick magnitude, (b) rat hindlimb flexion withdrawal reflex elicited by noxious thermal stimulation of the paw, and (c) a learned operant response (nose bar press) evoked by noxious thermal stimulation of the rat's tail. These models are discussed in terms of their advantages over previous methods measuring response threshold, their fulfillment of criteria for ideal pain assessment models, and the neuronal circuitry underlying the behavioral response.
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Within a prospective longitudinal study of 111 patients with acute radicular pain and lumbar disc prolapse who underwent conservative or surgical treatment, we examined the importance of specific pain coping strategies, which have received little attention in psychological pain research: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. Prior to treatment we conducted a psychological and neurological examination. The psychological tests included the Kiel Pain Inventory (KPI) and the Beck Depression Inventory (BDI). ⋯ Patients in group A were a specially high risk group: at the time of discharge they had no pain, but from the first week after discharge up to the 6-month follow up they had increasing pain. Additionally at the 6 month follow up they seemed less likely to return to work and 8 times more of them had applied for early retirement than in the groups of patients without psychological risk factors. The results suggested several suggestions for modification of medical and psychological therapy for chronic pain patients.