Der Schmerz
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Opioids are the oldest and most potent drugs for the treatment of severe pain but they are burdened by detrimental side effects, such as respiratory depression, addiction potential, sedation, nausea and constipation. Their clinical application is undisputed in the treatment of acute (e.g. perioperative) and cancer pain but their long-term use in chronic pain has met increasing criticism and has contributed to the current "opioid crisis". ⋯ The epidemic of opioid misuse has shown that there is a lack of fundamental knowledge about the characteristics and management of chronic pain, that conflicts of interest and validity of models must be more intensively considered in the context of drug development and that novel analgesics with less addictive potential are urgently needed. Currently, the most promising perspectives appear to be augmenting endogenous opioid actions and the selective activation of peripheral opioid receptors.
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Work-related fear avoidance beliefs play an important role when considering subjective work ability among people with back pain. Pain-related self-efficacy is known as a predictor for physical activity and subjective work ability. ⋯ Work-related fear avoidance beliefs among back pain patients seem to be important for subjective work ability in the short term. This especially holds true when patients have low self-efficacy beliefs. The investigated constructs should be emphasized in the patient-centered therapy. Longitudinal studies with larger samples and more frequent follow-ups should be investigated in future studies.
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To date only few studies have addressed the level of intelligence of children and adolescents with chronic pain. The few currently available studies suggest a cognitive performance of pediatric pain patients in the average range (IQ 85-115); however, only little is known about the relationship between pain characteristics and cognitive skills. ⋯ The results support the assumption that the intellectual performance of pediatric pain patients lies within the average range; however, the results indicate a limited competence in verbal abstraction and expressiveness of pediatric pain patients, which are negatively related to pain intensity. Further studies to examine causal relationships are needed.