Der Schmerz
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Progressive muscle relaxation (PMR) after Jacobson has been used for migraine prophylaxis since the early 1970s. Migraine patients are assumed to have an enhanced autonomic arousal which can be counterbalanced by systematic relaxation. Relaxation techniques are thought to reduce the activation level, to alter cortical pain processing and to enhance activation in pain-reducing cortical structures in the periaqueductal grey matter. ⋯ The initially increased CNV amplitude became normalized after regular PMR training in migraine patients. With the review of PMR studies on migraine prophylaxis and the results of our own study it could be shown that PMR is an efficacious non-pharmacological treatment option for migraine prophylaxis. In addition to its clinical effects, alterations in cortical stimulation processing in terms of a normalization of the CNV could be documented.
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Besides postictal headaches, epileptic seizures are infrequently associated with pain experiences. Nevertheless, seizure-associated pain is an important clinical symptom to recognize, diagnose and to differentiate from non-epileptic disorders. ⋯ Different aspects of pain phenomena in the context of epileptic seizures will be addressed by following these systematic classifications. In relation to seizures with unilateral somatosensory manifestation the functional anatomical context is described while differential diagnostic aspects in association with abdominal epilepsies are emphasized and terminological points as well as genetic epidemiological interrelationships between epilepsy and migraine are highlighted.
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Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. ⋯ Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
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Review Observational Study
[Avoidance-endurance fast screening (AE-FS) : Content and predictive validity of a 9‑item screening instrument for patients with unspecific subacute low back pain].
Among screening measures to assess psychosocial risk factors (yellow flags) for chronic low back pain (LBP) economic tools which address dysfunctional endurance pain responses besides emotional distress and fear-avoidance pain processing are rare. Targeting contrasting types of pain processing might improve stratified patient counselling. ⋯ The 9‑item AE-FS displayed sufficient prognostic validity for all three outcomes in a sample of primary care patients with subacute LBP. The differentiation of the high-risk patients into fear-avoidance and endurance-related pain processing enables the physician to provide an individualized counselling with the aim of a healthy balance between stress and relaxation.