Der Schmerz
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This study was designed to evaluate the efficacy of different strategies for migraine prophylaxis over a fairly long period. Metoprolol alone was compared with psychotherapy alone and with a combination of metoprolol and psychotherapy. The psychological programme was planned for future use in preventive treatment. In this paper only the results of the psychological therapy are described. ⋯ According to the results, the efficacy of the psychological treatment increases only gradually, as it has also been demonstrated for biofeedback and relaxation training [9]. Subjectively, patients rate the results of psychotherapy higher than those demonstrated by statistics. This may depend on the selection of patients, but also on the fact that subjective criteria of improvement are not contained in statistical evaluation. Responders and non-responders had initial differences regarding vegetative, hormonal and psychological factors. Responders had a more stable circulatory status, suffered more rarely from menstrual migraine and normally took significantly fewer analgesic drugs. On the whole, this psychological programme has proved quite effective.
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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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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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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.