Der Schmerz
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Many factors seem to be causal for non-specific low back pain and are sometimes controversially discussed. Some years ago the concept of subjective body image attracted attention but due to the inconsistent use of terms and concepts it is difficult to classify publications in the literature. Studies confirmed a difference between the body images of patients with low back pain and healthy controls so that an inclusion of body image concepts could be relevant for causation and therapy. ⋯ Further studies are necessary which include body image concepts as a possible psychosocial risk factor, in particular studies on the mechanism of body image procedures.
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In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.
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Review
[Emotion regulation and pain : Behavioral and neuronal correlates: a transdiagnostic approach].
Emotions and emotion regulation are of special importance in the perception and modulation of pain but the mechanisms underlying this reciprocal relationship remain unclear. The transdiagnostic model provides an approach to explain the link between pain and emotion regarding cognitive and neuronal mechanisms and aims to identify mutual processes, which are relevant for both. ⋯ The purpose of this review is to provide an overview of experimental and clinical studies of neuronal and behavioral correlates of pain-related emotion regulation. The current transdiagnostic approach may be able to enhance pain relief in the future.
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Research on placebo responses has made major progress in recent years. Placebo responses are psychobiological events, which are created by the entire therapeutic context. They can appear at any time, not only in experimental and clinical settings. ⋯ The current state of research suggests that placebo responses could be used in clinical contexts and should not be viewed as being in competition with medications but as an additive increase in efficacy of a pharmacological substance through specifically induced placebo responses. This targeted use is also possible within ethical guidelines. Important prerequisites are that the research results can be transferred from healthy participants to patients and that the placebo responses are reproducible.
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Review
[Baroreflex sensitivity and chronic pain : Pathogenetic significance and clinical implications].
The interaction of cardiovascular dynamics and pain perception is an important component of intrinsic pain regulation. In healthy subjects acute pain stimuli cause increased sympathetic arousal and increased mean arterial pressure. Arterial baroreceptors sense phasic blood pressure changes and relay the information to the lower brainstem via the dorsomedial nucleus tractus solitarius (dmNTS). ⋯ This article reviews the role of the baroreflex arc as a possible crucial factor in the development and maintenance of chronic pain. The importance of learning mechanisms is described. Mechanism-based individualized treatment approaches for patients with hypertensive stress reactivity are also critically discussed.