Der Schmerz
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Historical Article
[Pain asymbolia-discovered around 1930 by Paul F. Schilder, almost forgotten today?]
Paul Ferdinand Schilder was born in Vienna in 1886 and died in New York in 1940. Today he is remembered particularly as a psychoanalyst and a psychotherapist. His research in neuroscience, however, was also both comprehensive and innovative. ⋯ His publications on the condition are characterized by meticulousness, progressive thinking and critical reflection. He nosologically assigned pain asymbolia to the group of agnosias and integrated it into the concept of body image, which was a central issue in his entire scientific work. This article additionally addresses the question of whether Schilder's assumptions are still valid today and what consequences might arise from this.
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Chronic pain is a frequent and disabling health problem in children and adolescents and is associated with high health care utilization and costs. ⋯ An effective multimodal pain therapy may reduce health care costs in children and adolescents. Further economic studies are needed to evaluate long-term effects of pain therapy for children and adolescents with chronic pain in a controlled design.
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Complex regional pain syndrome (CRPS) is a disease of the limbs composed of various disorders and defined by the cardinal symptom of pain. So-called exergames with a combination of physical activity and fun are increasingly being offered as part of treatment. Exergame therapy could also provide CRPS patients with repetitive training, reward and motivation. ⋯ In this study the use of exergames proved to be a suitable tool for rehabilitation of the hand in adult CRPS patients. Whether exergames represent an effective rehabilitation strategy should be examined by means of functional and activity-related target criteria in a representative sample in a randomized controlled study.
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Interventional pain medicine plays an important role in pain therapy for neck and back pain. However, spine interventions are characterized by controversy between its proponents and its detractors. Detractors variously assert that the procedures practiced lack validity, are not effective, or produce complications that impugn the procedures. The Spine Intervention Society (SIS) published several articles over the last decade that answer and refute these criticisms.
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Interdisciplinary multimodal pain therapy (IMST) is recognized as a scientifically founded form of therapy for inpatient treatment of chronic pain conditions. The indications are assessed by private practitioners and must be confirmed by physicians at the inpatient institution. The health insurance companies are obliged to remunerate this treatment but are allowed to test the conditions in individual cases. ⋯ The transfer to a more intensive treatment sector must be made dependent on the severity and complexity of the symptoms and the insufficient effectiveness of the treatment in the previous sector. Simple ICD-10 diagnoses are not suitable as decision-making criteria and therefore, also not as testing criteria for the indications for inpatient treatment. Decompensated and acutely exacerbated chronic pain conditions must as a rule be treated in hospital, also due to the mental component of the pain disease.