Der Schmerz
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In modern oncology, paradigmatic developments can be witnessed with respect to conceptual strategies and to individualized diagnostics and treatment approaches, but foremost with respect to the amazing number of new anticancer substances available. These developments will certainly influence the care of patients suffering from incurable and advanced cancer, where pain therapy and symptom control, quality of life and other intentions of palliative care are urgent. For cancer pain therapy and palliative care, knowledge about these developments may be helpful not only with respect to interdisciplinary decision making, but also for thoroughly balancing risks, side effects and benefits of oncological interventions that have the potential to stabilize disease progression and thereby reduce symptom intensity.
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"Diffuse noxious inhibitory controls" (DNIC) refer to the observation that the activity of multi-receptive neurons of the spinal cord and trigeminal system can be strongly suppressed by an intensive pain stimulus outside their peripheral receptive field. This effect represents a neurophysiologically well-established animal model of endogenous pain modulation that has been consistently demonstrated across different species. ⋯ It is assumed that, corresponding to the animal model, the perceptive effects of 'heterotopic noxious conditioning stimulations' (HNCS) in humans are predominantly based on the DNIC mechanism. This review focusses on DNIC and HNCS including similarities, divergences and their potential clinical relevance.
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Chronic postoperative pain is known to be a significant clinical and economic problem. The estimated mean incidence is high and varies between 10 and 50%, with variations mostly related to procedure-specific conditions. High-risk types of surgeries are e.g. thoracotomy, breast or inguinal hernia surgery and amputations. ⋯ The perioperative identification of patients who are at high risk for developing chronic pain after surgery is therefore a major goal for the future. This may help to develop preventive treatment strategies and avoid treatments with side effects for patients who are not at risk for developing chronic pain after surgery. Due to a lack of appropriate data for sufficient preventive approaches an effective postoperative acute pain management and a nerve-conserving surgical technique are the major keys in the prophylaxis of chronic postoperative pain.
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Fibromyalgia poses a challenge for therapy. Mainly comorbid depression has a negative impact on symptoms and impairment in patients with fibromyalgia. This paper gives a systematic overview of how depressiveness affects physical and psychological impairment, coping with disease and rehabilitation outcome among patients with fibromyalgia. The databases PubMed, Embase and PsychINFO were searched for studies published up to April 2010. ⋯ Fibromyalgia patients with depressive symptoms show more sleep disturbances, sexual dysfunction, loss of physical function level and lower quality of life. Patients with fibromyalgia and comorbid depression showed poorer outcomes of multimodal rehabilitation than patients with fibromyalgia without depression. Therefore the assessment of depression should be included in the routine diagnostics of fibromyalgia. Furthermore, patients with fibromyalgia and comorbid depression should be motivated to seek therapy and get better support in coping with depression.
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Fibromyalgia poses a challenge for therapy. Mainly comorbid depression has a negative impact on symptoms and impairment in patients with fibromyalgia. This paper gives a systematic overview of how depressiveness affects physical and psychological impairment, coping with disease and rehabilitation outcome among patients with fibromyalgia. The databases PubMed, Embase and PsychINFO were searched for studies published up to April 2010. ⋯ Fibromyalgia patients with depressive symptoms show more sleep disturbances, sexual dysfunction, loss of physical function level and lower quality of life. Patients with fibromyalgia and comorbid depression showed poorer outcomes of multimodal rehabilitation than patients with fibromyalgia without depression. Therefore the assessment of depression should be included in the routine diagnostics of fibromyalgia. Furthermore, patients with fibromyalgia and comorbid depression should be motivated to seek therapy and get better support in coping with depression.