Der Schmerz
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The aim of this investigation has been to test in humans the reliability and validity of three painful stimuli, i.e, mechanical pressure, a modified submaximum-effort tourniquet technique, and the cold pressure test. Twenty-four untrained subjects (twelve females, twelve males) volunteered in the experiments and, after a trial session were presented with four runs of these three noxious stimuli within 36 h. They assessed the painfulness using a direct scaling technique (category subdividing procedure). ⋯ Repeated mechanical stimulation caused sensitization that did not occur with ischemia or cold. There were no significant differences whether the experiments were performed in the morning or in the evening. Experimental pain induction either by mechanical pressure or by ischemia judged in accordance with the category subdividing procedure produce reliable and valid results; the methods are easily applicable and economic.
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Chronic pain is a complex experience that may change the life of the patient totally. Being influenced by numerous factors, communication between the physician and the patient on such a complex experience is not always easy. ⋯ Our results showed that the new method is appropriate to evaluate the intensity of pain in patients with chronic pain, but no to explore the patient's psychological state. The patients' assessment showed clearly that they preferred the dolorimeter to evaluate their pain intensity while they preferred a verbal scale (Profile of Mood States) to describe their mood state.
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This epidemiological questionnaire-study of 362 patients suffering from chronic pain related to musculoskeletal disorders showed the following results: Most musculoskeletal pain syndromes are located in the head and back areas (57.3%). Patients who seek treatment in an orthopedic pain clinic suffer from at least moderate pain according to the verbal rating scale and from pain equal too or more than 50 on to the numeric rating scale. For most patients (51.9%) the duration of the pain has been between 1 and 10 years. ⋯ Most patients with chronic pain consult 2 to 6 doctors. For typical orthopedic pain syndromes most patients consult an orthopedist. Patients with chronic headaches consult an orthopedic specialist about as frequently as neurologist or internist specialist.
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In the past the view has often been expressed that children are less sensitive to pain than adults as a result of the assumption that their nervous system is not as well developed. According to this theory, newborns were not supposed to feel pain at all, and for this reason minor surgery was often performed with inadequate anesthesia. Evidence in the more recent literature and the regular choice of "pain in children" as a topic for congresses exemplify the more and more widespread belief that children of all ages can feel pain and, relative to their developmental stage, suffer accordingly. ⋯ As cognition develops further, the patient's own concept of health and sickness changes, as does the ability to express feelings of pain. In the pathogenesis of pain in children, the dominant types are nociceptor pain (e.g., as a result of trauma or infection) and pain resulting from malfunction (e.g., physical malposition, migraine), whereas nervous pain occurs less frequently. Pediatricians should pay particular attention to the treatment of acute and chronic pain in children.