Der Schmerz
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Several studies of contingent negative variation (CNV) examined whether this method provides a suitable basis for research on pathogenetic processes in chronic headaches-especially migraine. In the present study, the CNV amplitudes and CNV course of 23 migraine patients were compared with those of 22 healthy subjects. CNV was calculated for (a) "total interval", (b) "early CNV component", and (c) "late CNV component". ⋯ The results allow the assumption that the higher level of CNV amplitude in migraine patients is not only due to higher cortical noradrenergic or serotoninergic activation. This study shows that migraine patients cannot decrease their CNV amplutides. This is probably due to defective processing of sensory imput.
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Our knowledge of the risk factors involved in the process by which acute pain becomes chronic has improved. Psychological conceptualizations of chronic pain presently include (1) the pain-tension cycle, with special reference to a diathesis-stress model, (2) the operant conditioning model, and (3) the interrelationship between vulnerability to pain attacks on the one hand and body posture, gait and activities of daily living on the other. With reference to these conceptualizations and to psychological procedures for the enhancement of self-management strategies, a low back school was implemented at the worksite as a preventive measure. The target population is characterized by (1) rare but recurrent pain episodes, (2) mild pain that has had little impact on daily activities, and (3) pain contingent on particular activities or situations. LOW BACK SCHOOL: A low back school called "Turn your back on backache" consists of the following elements: (1) analysis of labour conditions and adaptation of the worksite to the person, (2) relaxation and stress management, (3) training of posture, gait, and activities of daily living, and (4) stretching and stengthening of the muscles involved. The programme comprises 12 2-h sessions and is conducted by a physiotherapist according to a manual, after an introduction to self-management procedures including behavioural training for working with groups. For homework, participants are asked to practise the exercises demonstrated. ⋯ (1) A back school training for the worksite results in a decreased frequency of back pain episodes and an increase in reported health status and wellbeing. (2) The effects of behavioural training of posture, gait, and activities of daily living in hospital staff are clearly demonstrated by observational methods. (3) Assuming that present posture, gait, and daily activities are interrelated with future pain conditions, an increase in the exercise of adequate behaviours indicates a preventive effect of the back school programme.
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The quantitative approach to the study of descending inhibition of spinal nociceptive transmission was initiated in Heidelberg through the use of natural, noxious stimulation and examination of the modulation of the encoding properties of spinal dorsal horn neurons. This important approach required control of the noxious stimulus, which had previously been inadequately considered, and the parametric assessment of modulatory influences on the encoding properties of spinal dorsal horn neurons. As a consequence, descending inhibition of spinal nociceptive transmission was found not to be homogeneous throughout the brainstem, but rather to be significantly different from different brainstem nuclei. ⋯ Most recently, the same approach has been profitably applied to studies that have focused onfacilitatory influences descending from many of the same brainstem sites. As a consequence, it has been proposed that there exists an endogenous pain facilitating system analogous to the well-accepted endogenous pain inhibitory system. While the function of the facilitatory system remains unknown, it is proposed that it may be important to long-lasting pain conditions that exist in the absence of pathology.
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Within a prospective longitudinal study of 111 patients with acute radicular pain and lumbar disc prolapse who underwent conservative or surgical treatment, we examined the importance of specific pain coping strategies, which have received little attention in psychological pain research: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. Prior to treatment we conducted a psychological and neurological examination. The psychological tests included the Kiel Pain Inventory (KPI) and the Beck Depression Inventory (BDI). ⋯ Patients in group A were a specially high risk group: at the time of discharge they had no pain, but from the first week after discharge up to the 6-month follow up they had increasing pain. Additionally at the 6 month follow up they seemed less likely to return to work and 8 times more of them had applied for early retirement than in the groups of patients without psychological risk factors. The results suggested several suggestions for modification of medical and psychological therapy for chronic pain patients.
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This study presents the first-ever account of the prevalence of headache syndromes in Germany and the frequency with which they occur in a large representative sample according to the International Headache Society criteria, as set out in the German translation approved by the Classification Committee. 5000 persons representative of the total population were selected from a panel of 30000 households and requested to answer a questionnaire about headache occurrence during their life to date (lifetime prevalence). Of the 5000 persons who were sent questionnaires, 81.2% (n=4061) completed and returned them: 71.4% (n=2902) said they suffered from headache at least occasionally. Of the base population (all respondents: 100% orn=4061), 27.5% (n=1116) fulfilled the criteria for the IHS classification ofmigraine, 38.3% (n=1557) displayed the criteria oftension headache and 5.6% (n=229) said they suffered from headaches, but did not fulfil the criteria for either migraine or tension headache and were therefore classified in the category other headache. ⋯ The importance of the neurological disorders migraine and tension headache is currently seriously underestimated. They are one of the major health problems of our time. There is an urgent need for much greater attention to them by the health system.