Der Schmerz
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Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. ⋯ Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders.
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Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women. ⋯ Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.
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The psychophysiology of visceral pain is--different from cardiac psychophysiology--much less well investigated due to the invasiveness of its methods and problems associated with reliably and reproducibly stimulating as well as recording of the gastrointestinal tract. Despite these problems, the last 30 years have documented a number of psychophysiological phenomena such as the perception (interoception) of visceral stimuli, the effect of emotions and stress on visceral sensations, and the effect of visceral processes on cortical processing. This was mainly due to the application of neurophysiological techniques (cortical imaging and stimulation) in these investigations.
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Chest pain is a symptom commonly reported by persons in the general population and represents a differential diagnostic challenge. ⋯ There is a need for controlled studies on the symptomatic treatment of pain in irritable esophagus, non-cardiac chest pain, postmastectomy and poststernotomy syndromes.
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Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. ⋯ Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity.