Der Schmerz
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Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10% of patients with herpes zoster develop postherpetic neuralgia. ⋯ Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants, antiepileptic drugs, opioids, and topical capsaicin and lidocaine. Nevertheless, about one third of patients do not respond to conventional treatment. Given the fact that postherpetic neuralgia is considered to be a chronic pain disease, a multidisciplinary treatment approach is necessary.
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Neuropathic pain is caused by lesions in the somatosensory system. Characteristic but not exclusive features are spontaneous burning pain, electrifying and shooting pain, hyperalgesia, and allodynia. The basic concept of the pathophysiology of neuropathic pain is the combination of peripheral and central sensitization. ⋯ In addition, there are many more therapeutic options available than 15 years ago. The drugs available include antidepressants, anticonvulsants, opioids, and topical medications. Data from controlled trials and recommendations from guidelines are available.
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Review Comparative Study
[Gender differences in acute and chronic pain conditions : Implications for diagnosis and therapy.]
Gender differences can influence incidence and outcome of acute and chronic pain conditions. The reasons are to be found in genetic factors, hormonal effects and differences in anatomy and physiology. Furthermore differences relating to psychiatric comorbidities (i.e. depression) and psychosocial factors (roles, coping strategies) have been demonstrated. ⋯ There is a gender bias in diagnosis and therapy. There is a need to study the influence of gender, age and race in order to optimize treatment towards a more individualized therapy. This article highlights already identified differences.
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Burnout is not a medical diagnosis but a developmental aberration which is associated with the risk of subsequent mental and somatic diseases. It can be summarized under a fatigue process with stress symptoms, societal-linked stressors and a driving force stress intensifier. In the mental stress circle, burnout presents as an accelerated vicious spiral driven by high demands. ⋯ Burnout is also a meaning of life crisis, triggered by the narrowing of performance and success. The anthropological therapeutic approach targets an enhancement of self-conception and lifestyle. Other available therapy approaches for burnout include pharmacotherapy, coaching, management consulting and inpatient treatment.
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Review
[Multidisciplinary assessment for multimodal pain therapy : Indications and range of performance].
According to evidence-based German national guidelines for non-specific low back pain, a broad multidisciplinary assessment is indicated after persisting pain experience of 6 weeks in order to check the indications for an multi- and interdisciplinary pain therapy program. In this paper the necessary topics, the content and the disciplines involved as well as the extent of the multidisciplinary assessment are described as developed by the ad hoc commission on multimodal pain therapy of the German Pain Society.