Der Schmerz
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Pain has a complex pathophysiology that is expressed in multifaceted and heterogeneous clinical phenotypes. This makes research on pain and its treatment a potentially data-rich field as large amounts of complex data are generated. Typical sources of such data are investigations with functional magnetic resonance imaging, complex quantitative sensory testing, next-generation DNA sequencing and functional genomic research approaches, such as those aimed at analgesic drug discovery or repositioning of drugs known from other indications as new analgesics. ⋯ In addition, knowledge discovery in big data accessible in electronic knowledge bases, can be used to generate hypotheses and to exploit the accumulated knowledge about pain for the discovery of new analgesic drugs. This enables so-called data-information-knowledge-wisdom (DIKW) approaches to be followed in pain research. This article highlights current examples from pain research to provide an overview about contemporary data scientific methods used in this field of research.
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Interdisciplinary multimodal pain therapy (IMPT) should be delivered in a personalized, mechanism- and goal-oriented manner on the basis of an individual case conception. To the authors' knowledge, a practical instrument for planning IMPT does not exist. ⋯ Based on the relevant interference mechanisms, goals for change and treatment are set and possible interventions are proposed. This involves explicitly including the patient's existing resources.
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This article presents the case of a 46-year-old woman with fibromyalgia with an undetected fracture of the coccyx. The heterogeneity of the symptoms of patients suffering from fibromyalgia including chronic widespread pain, vegetative and functional disorders, mental and physical exhaustion as well as sleep disorders can cause accidentally undetected comorbidities, especially if these are rare and predominantly present with pain as the main symptom. In the present case the reason for symptoms was detected only after 14 months of ineffective therapies and diagnostic procedures. ⋯ It should be nevertheless emphasized that patients with fibromyalgia suffer from a central pain-processing disorder. Indications for operative treatment must be very carefully considered. Surgery should only be considered in consultation with the patient and after failed conservative therapy.
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The effect of integrating clinical pharmacists in German palliative care units with regard to the quality of drug therapy and drug costs has yet not been evaluated. ⋯ The results indicate that the integration of a clinical pharmacist is well suited to optimizing the interprofessional treatment of distressing symptoms with a beneficial economic outcome in palliative care. Consequently, the permanent integration of a clinical pharmacist on an inpatient palliative care unit seems to be beneficial and advisable.