Therapeutische Umschau. Revue thérapeutique
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Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. A painful stimulus elicits an activation of receptors in the periphery which transduce the stimulus into an electrical impulse. This electrical impulse is transmitted to the dorsal horn of the spinal cord and subsequently to the brain. ⋯ In parallel, endogenous control mechanisms, in which predominantly the opioid but also other systems are involved, counteract these pathological changes. Both the initiation of pain and its control can be regarded as the body's response to prevent further injury, to support wound healing, and to return to a normal function as quickly as possible. The transition from acute to chronic pain may critically depend on disturbances of the intrinsic pain control mechanisms as well as on effective therapeutic measures, initiated at the earliest possible time.
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International headache classification systems presently differentiate between more than 150 types of headaches and facial pain. This paper subdivides the most frequent types of pain according to the duration of typical manifestations. ⋯ In most of these clinical pictures, the diagnosis has to be established on the basis of a carefully evaluated case history. Indications for additional technical examinations are critically assessed.
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Back pain is a common disease causing tremendous costs for treatment, work loss and pension payments. The reasons of back pain vary considerably and often remain doubtful. ⋯ Active treatment procedures should be preferred. In chronic pain patients only multimodal concepts of treatment seem to be successful as far as they take care of somatic, psychosocial, ergonomic and sport physiological aspects.